第六章 同理理解：社会因素如何影响自我认知
第六章
同情的理解：自我的社会塑造
正如我们所讨论的，CFT中的自我和他人同情始于认识到许多来访的挑战与他们无法选择或设计的因素有关。在过去的两章中，我们探讨了这一点的第一部分——认识到我们的大脑经过进化形成了产生难以管理的情绪的能力。然而，还有一个重要的认识。从我们出生的那一刻起，我们进化遗传潜力（基因型）就与另一组我们无法选择或设计的因素相互作用并被其塑造——我们的早期社会环境。
作为婴儿，我们完全依赖于照顾者，他们可能或不可能具备养育我们并帮助我们管理这些强大情绪的能力。现在我们知道，不同的人天生具有非常不同的气质——更容易或更不容易经历焦虑和易怒等情绪。这些气质随着时间的推移与我们的早期社会环境相互作用，塑造了我们将成为的人。
越来越多的研究表明，这些早期环境对我们的大脑发育产生了深远的影响，特别是与情绪调节和社会信息处理相关的区域（Siegel, 2012; Cozolino, 2010）。随着我们进入童年、青少年和成年早期，我们对所处环境的影响力逐渐增大，但仍受社会力量的影响，这些力量可能会模仿和强化日后可能使我们陷入困境的习惯。认识到我们如何被社会力量塑造，可以支持来访发展自我同情，因为他们意识到他们感到最羞耻的方面并不是偶然形成的，也不是由他们自身固有的缺陷引起的。
自我的不同版本
如果你参加过很多CFT研讨会，你可能会听到类似以下的故事： “我出生在一个受过教育的中产阶级家庭，父母慈爱，能够照顾我并提供我生存和发展的必需品——食物、住所、衣物、关爱和参与有趣活动的机会。他们支持并鼓励我的教育，教会了我生存所需的技能——如何学习、管理财务和无数其他事情。但假设我出生在一个单身毒瘾母亲的家庭，位于贫困的城市贫民窟。假设我经常饥饿和孤独，没有人在我需要帮助时照顾我，反而被那些本应帮助我的人虐待。假设我不得不学会偷窃来养活自己，战斗来保护自己，卖毒品或犯其他罪行来赚取生活所需的钱。那么，现在的我——大学教授、心理学家和作者——是否有可能成为现实？是否有可能实现？”
我们都有基本需求，我们学会了在所处环境中产生满足这些需求的行为——这些环境往往是无法选择的，但我们必须适应以求生存。这里的核心思想是，我们每个人都只代表了我们可能成为的众多版本之一——这一版本是由我们的生活经历与遗传构成之间独特的互动模式定义的。我们和我们的来访都受到了早期依恋关系以及早期和持续的学习经历的深刻影响。考虑这些社会力量是帮助来访发展对自己和他人的同情的重要步骤。这也帮助他们承担起应对当前社会和物理环境的责任，因为他们逐渐意识到这些环境如何影响他们的人生轨迹。
自我的社会塑造
在治疗中，帮助来访探索当前体验与生活中的社会背景之间的关系是有用的。下面我们简要触及其中的一些方面，以及如何将它们引入治疗室。由于篇幅有限，我会快速介绍这些主题，但对于希望深入了解的人来说，还有很多其他资源可用。
依恋历史和依恋风格
在前一章中，我们探讨了人类如何进化到主要在与接受我们并关心我们的人建立联系的背景下感到安全（Gilbert, 2009a; 2010）。John Bowlby 和随后的依恋研究人员描述了早期社会环境如何塑造我们对他人以及自己与他人关系的基本理解。通过这种方式，早期的依恋历史产生了相对持久的依恋风格，这些风格塑造了我们将如何体验与他人的关系，以及我们在世界中感到安全的能力。
不同的作者使用了不同的方法来分类和标记依恋风格。为了我们的目的，我将从三个影响情绪调节的过程来讨论依恋：依恋安全感、依恋焦虑和依恋回避。依恋安全感通常源于与响应我们需求的养育照顾者的互动。安全个体学会在需要时可以获得帮助，并发展了一套有效的自我情绪调节策略（Mikulincer & Shaver, 2007）。从CFT的角度来看，安全的依恋关系激活了安全感系统，建立了和加强了促进个体自我安抚能力的神经网络，使他们在有效应对基于威胁的情绪时能够自我安抚。能够自我安抚的安全个体可以保持对情绪的开放——以适应的方式承认、感受和表达情绪（Mikulincer & Shaver, 2007）。这些个体还学会了珍惜自己——被关爱的历史教会了他们自己值得关爱和善意。
依恋焦虑通常源于不可靠且对孩子痛苦反应不一致的抚养环境。依恋焦虑与渴望连接但无法信任这种连接会在需要时存在，或担心它会不可预测地消失有关。因此，即使在有社会关怀或连接的情况下，这些个体也可能无法感到安慰。高依恋焦虑水平的来访可能会以夸张和非常强烈的方式体验威胁情绪——可能是受到仅在孩子表现出极度痛苦时才提供关怀的照顾者的隐性塑造（Mikulincer & Shaver, 2007）。由于难以自我安抚或调节情绪，这些个体可能似乎生活在威胁系统中，反复思考感知到的威胁，并对社会威胁的迹象高度敏感。他们对他人感兴趣，但在管理关系方面有困难，可能非常害怕被拒绝。
对比：依恋回避个体
相比之下，高依恋回避的个体采用了很多策略来抑制、压抑或避免他们的情感体验。通常由不可用或不响应的照顾者抚养长大，回避型个体倾向于保持人际距离，独自行事，并可能认为寻求支持是有风险的、不舒服的或徒劳的。由于无法通过与他人的联系和支持来安抚自己，这些个体转而采用回避策略——疏远、否认和最小化他们的情感。这些策略会妨碍有效的应对，因为来访会避免而不是参与解决问题、寻求支持或以更有帮助的方式重新评估他们的处境（Mikulincer & Shaver, 2007）。从CFT的角度来看，回避型个体被认为拥有未充分发展的安全感系统，无法用于安抚自己和应对情绪，而是依赖于基于威胁的回避策略（称为安全策略），这些策略往往有长期的负面影响。
我们的来访无法选择他们在与他人的关系中是否感到安全，是否对处理情绪有信心，以及是否感觉自己是连接的、脆弱的或孤立的。如果这些是选择，当然我们都会选择感到安全、自信和连接。我们无法改变过去，但可以帮助来访开始理解他们为何会这样，以及这些经历不是他们的错：
治疗对话示例
治疗师：珍妮，上一次我们谈到了我们如何感到受到威胁或安全，以及这些经历如何组织我们的思维——我们如何注意、体验情绪、思考等等……
珍妮：是的，我记得。
治疗师：很好。在CFT中，我们还考虑人们如何学会感到安全或受到威胁——很多时候，这与我们与他人的关系历史有关。我们之前也讨论过这一点——你在中学时和其他女孩的糟糕经历让你在社交场合感到不安全。
珍妮：没错。那太糟糕了。它让我非常害怕与其他人相处。
治疗师：这让你很难冒险信任别人，害怕建立关系？
珍妮：几乎不可能。
治疗师：当那件事发生时——你转到新学校，其他女孩对你很刻薄——你有没有和任何人谈论过这件事？
珍妮：我试着和妈妈谈过，但她并没有真正帮到我。我是说，她尽力了，但我感觉她并不理解。她告诉我，女孩有时候就是这样，我不应该把它看得太重。
治疗师：所以她并没有真正帮到你？
珍妮：嗯，她自己也过得不好。她和爸爸刚离婚，他们的婚姻已经不好很久了。真的很糟糕。他背叛了她，她也开始酗酒。离婚后我们搬了家，情况更糟了。
治疗师：所以她的生活一团糟，很难为你提供支持？
珍妮：是的。我是说，她尽力了。她真的尽力了。她好像知道自己不是一个好母亲。她甚至有时会这样说，然后试图弥补。她会给我买昂贵的牛仔裤之类的东西。但大多数时候……（摇头叹气）
治疗师：大多数时候？
珍妮：大多数时候她都不在状态。爸爸在家时，她显得不开心，搬家后，她总是忙于自己的事。
治疗师：你的爸爸呢？
珍妮：他是一个典型的缺席父亲。他大部分时间都不在——要么工作，要么做别的事。
治疗师：当他在家时，你们的关系怎么样？你还记得和他一起做过的事情吗？
珍妮：我很喜欢和他在一起，但他不在的时间太多了。离婚后，他说想和我保持关系，但从未真正付诸行动。他会打电话安排周末接我出去，但一半时间他都不会出现。后来他就不再打了。我想他更关心他的新家庭。（低头，有些泪眼汪汪）
治疗师：（沉默片刻）
珍妮：（叹气）我想我有一个很差劲的父母，是吗？
治疗师：听起来他们确实有很多自己的问题，这些问题妨碍了他们为你提供支持。还记得我们谈到的安全感系统，以及我们如何通过与关心我们的人建立联系来感到安全吗？考虑到这一切，你觉得你为什么很难在关系中感到安全，很难相信别人会在你需要的时候出现？
珍妮：这确实有道理。
治疗师：你没有学到在需要帮助时可以依靠别人，而是学到了有时候他们会在那里，而……
珍妮：很多时候他们不会。
治疗师：珍妮，考虑到这种学习经历，你觉得你在关系中感到不安全是你的错吗？你觉得你很难信任别人会在你需要时出现是你的错，还是这是你生活教给你的？这是你的错吗？
珍妮：不，这不是我的错。
治疗师：（停顿片刻）你能再说一遍吗？
珍妮：（哭泣）这不是我的错。
如上所述，在CFT中，重点不在于将人按依恋风格分类，而是帮助来访以非指责、同情的方式理解他们的情感、动机和行为。来访有很多方式会感到不安全，或者形成不符合他们理想生活的习惯。让我们进一步探讨一些其他方面。
学习理论与行为疗法
学习理论和行为疗法已成功应用于理解和治疗各种情绪和行为问题。CFT与这些方法非常兼容，理想情况下，CFT治疗师应接受过基本行为原则的培训，了解这些原则如何应用于心理问题的理解和治疗。尽管行为主义者和行为主义并不总是被视为温暖和富有同情心的，但仔细观察后，我们会发现行为理论本质上削弱了羞愧和自我攻击的核心。它们帮助我们和我们的来访清楚地理解他们的问题是如何习得的，以及在考虑这些问题发生的背景时，这些挑战是完全合理的。将这些挑战视为习得的而非自身固有的错误，可以帮助来访对自己产生同情（“我有这样的困扰并不是我的错”），并在我们以同情的方式解决这些问题时为我们指明方向。关于学习理论和行为疗法有许多优秀的资源，因此在这里我不会详细展开，但我想简要提及一些学习方法以及如何将这些理解融入CFT。
操作条件反射与行为的功能分析
行为的功能分析在帮助来访回答“我为什么会这样做？”的问题时非常有用。进行功能分析涉及找出控制特定行为发生的因素——哪些因素为行为的发生设置了舞台，以及随之而来的后果是什么。这个过程通常用A-B-C的缩写表示，分别代表前因（Antecedent）、行为（Behavior）和后果（Consequence）。在进行功能分析时，我们首先选择一个特定的行为。这可以是来访可观察到的行为，也可以是私密行为，如思考（例如，自我攻击或反复思考）。
一旦确定了我们感兴趣的特定行为，我们就会寻找该行为的前因——即在其之前出现并预示其可能发生的因素。前因可以是外部因素（刺激物），这些刺激物信号表明惩罚或奖励的存在，触发相关行为的发生（称为辨别刺激，因为它们使我们能够检测或区分威胁和奖励的存在）。前因也可以是内部体验，这些体验与个人喜欢或不喜欢的事物无关，而是涉及动机状态，这些状态为某些行为的发生“设置舞台”，影响行为是否会有令人愉悦或不悦的后果。饥饿是一个很好的例子。我们可以看到它是如何工作的：无论食物的一般可获得性如何，当我们饥饿时，进食对我们来说更加令人愉悦。这样，前因既可以让我们知道奖励是可用的（发挥辨别功能），也可以激励我们去寻找奖励（发挥动机功能）（Törneke, 2010）。关键在于，前因使我们对行为之后可能出现的积极或消极后果有所预期，为这些行为的发生设置舞台。
一旦我们确定了感兴趣的行为及其前因，我们就可以探索随之而来的后果，这些后果会影响该行为在未来发生的可能性。有些后果是强化的，增加行为重复的可能性。这可以是因为后果是个人偏好的，例如考试前复习后得到好成绩（正向强化），或者是因为它涉及终止或去除个人不喜欢的体验——比如药物缓解头痛（负向强化）。
其他后果称为惩罚，减少行为重复的可能性。这可能是因为行为的后果是令人厌恶且不受欢迎的（称为惩罚或正向惩罚——其中正向指的是不希望的后果的增加），例如尝试回答问题后被嘲笑。惩罚也可能发生在后果涉及终止或去除个人喜欢的事物时，例如讲了一个冒犯性的笑话后朋友疏远你。这有时被称为负向惩罚——其中负向指的是偏好状态或情境的去除——或反应代价（即行为或反应有代价）。
与来访进行功能分析可以帮助他们理解他们参与的行为——他们可能对此感到非常羞愧和自我批评——在考虑背景时实际上是合理的。例如，监狱囚犯的攻击行为在他一直生活在危险环境中时变得非常合理，因为攻击意味着其他人会远离他，而不是针对他进行伤害。
治疗对话示例
克里斯：当我差点杀了那个人后，其他人都离我远远的。我想他们觉得不值得——这对我来说也很好。他们知道我随时可能爆发。他们知道如果你惹我，你会受伤，而且伤得很重。
治疗师：听起来你是通过变得暴力来保护自己——如果你足够强硬，人们就会离开你——而这确实奏效了。如果我们这样想，你觉得你会学会变得暴力，维持这种形象，这是否有道理？
克里斯：当然有道理。但那不是我想成为的人。那不是我希望儿子拥有的父亲。
治疗师：所以那个暴力的你确实起到了作用，但我们不想让他继续掌权。我们能不能努力发展另一个版本的你，符合你希望成为的那种父亲？
克里斯：听起来不错。
同样，当我们认识到来访的自残行为为她提供了暂时的痛苦解脱时，我们可以以同情的态度理解她为何不愿放弃这种策略。这些来访在努力停止对自己造成巨大问题且不符合他们希望成为的人的行为时，可能会经历强烈的羞愧和自我批评，但这些行为在他们的生活中确实（或曾经）有非常实际的目的。这种羞愧和自我批评可能会反常地使他们陷入威胁系统，阻碍他们承担责任以改变行为，因为他们通过责怪他人、合理化自己的行为或简单地转移注意力来避免与羞愧相关的不适。我们在那些与生活塑造的行为作斗争的来访中反复看到这些主题——这些行为是为了满足他们的需求并保护自己而发展起来的。帮助来访理解这些行为在他们的历史背景下是合理的，可以将焦点从自我攻击转移到以同情的方式找到更有帮助的策略，以追求这些非常崇高的目标——保护自己和应对痛苦。
在CFT的语言中，我们发现许多来访似乎生活在威胁系统中——他们的生活和行为集中在减少或避免不舒适的体验上。这就是行为主义者有时所说的“行为处于厌恶控制下”（Skinner, 1953），也是佛教徒在谈论厌恶时提到的。在CFT中，我们帮助来访不仅减少威胁和不适的体验，还要培养和加强一种以帮助自己感到安全为导向的同情自我（削弱厌恶控制），探索解决他们挑战的有益方法（而不是仅仅试图避免或逃避与这些挑战相关的不想要的情绪），并朝着他们希望的生活方式前进（而不是远离他们不希望的生活方式）。通过这种方式，我们看到CFT与像ACT（强调价值观工作）和DBT（强调适应性技能的发展，如压力耐受和情绪调节技能）这样的方法有许多共同之处。
反应性条件反射
除了学习前因、行为和后果之间的联系外，我们的大脑也非常高效地学习不同刺激之间的联系。某些刺激——事件、经历、环境中的事物，甚至是想法或心理意象——自然具有引发我们某种反应的能力。我们可以从前面章节讨论过的三种情绪调节系统（威胁、驱动和安全感）的角度来考虑这一过程。例如，生命受到威胁的情况（如车祸）可以自然引发恐惧。性刺激可以自然导致性兴奋。与亲爱的朋友共进晚餐时的温馨交谈可以带来舒适和安全感。让我们想象三个不同的人，分别处于这三种情况之一——一次可怕的车祸、一场热烈的激情爱爱、与亲爱的人共度温馨晚餐。由于每种情况都会自然引发反应，我们称这些情况为无条件（未习得的）刺激，而由这些刺激自然引发的反应（恐惧、性兴奋、安全感）则称为无条件（未习得的）反应。
假设在这三种情况下，收音机里都在播放同一首歌。我们的大脑非常善于将事物联系在一起，因此对于每个人来说，这首歌都可能与所处的情况（车祸、性爱、与亲爱的朋友互动）联系起来。将来，这些人可能会对这首歌产生非常不同的习得反应，通过它与这些情况的联系。车祸中的人听到这首歌会感到一阵恐惧。爱人听到这首歌会感到性欲上升。朋友听到这首歌会感到温暖的安全感和平静。这首歌曲的形式（即它是什么）对每个人来说都是相同的，但它的功能（即它的效果——它做了什么）完全不同，这是由于它之前与这些不同情况的配对。在每种情况下，个体都学会了对这首歌产生情感反应，现在这首歌作为一个条件（习得的）刺激，能够引发条件（习得的）反应——恐惧、性兴奋或安全感。这一学习过程是反应性条件反射的一个例子（也称为经典条件反射）。
值得一提的是，进化使我们具备了不同的学习能力——某些类型的学习，有时称为准备学习，在我们的祖先那里具有更高的生存价值，因此我们能够更快、更有效地形成这些心理联系。例如，在强烈威胁情绪（如恐惧或厌恶）的情况下，我们可以在一次试验中学会这种联系——即使只经历过一次车祸，幸存者下次听到这首歌时也可能感到极度恐惧。而在性爱的情况下，可能需要几次类似的激情经历，这首歌才能获得独立触发性感觉的能力（尤其是在这首歌也在其他时间播放的情况下）。我们可能需要整个夏天在湖边与好友烧烤，这首歌才会强烈唤起安全感。特别是，我们的大脑倾向于处理威胁信息——这就是为什么来访很容易学会在各种情况和触发因素面前感到威胁，并且很难学会感到安全，尤其是当他们早期的环境很少提供安全感的经历时。许多来访会报告在看似相对轻微的情况下或“无缘无故”地出现强烈的情绪反应，如恐惧、愤怒或悲伤。这些经历可能令人恐惧，可能导致来访将他们自己的情绪视为强大、不可预测的力量，随时可能袭来，使来访感到“疯狂”、脆弱和无助。我们可以想象，这样的经历可能会让来访觉得自己的情绪是威胁性的，并努力避免这些情绪。这些经历还可能引发来访的自我批评，因为他们认为没有理由感到这样……一定有什么地方不对劲。逻辑的新大脑往往无法看到或理解旧的情感大脑在回应什么，所以它会归咎于受害者。
在这里，我们可以帮助来访探索他们是如何习得这些情感反应的，以及考虑到这些学习经历，他们的情感反应及相关动机（例如，逃避或避免触发情绪的情境的愿望）是完全合理的。他们没有任何问题——他们只是拥有一个非常努力地让他们保持安全的大脑，通过识别所有以前学过的与危险相关的信号来工作——即使这些信号（如我们的歌曲）根本不是危险的。通常，来访甚至没有意识到他们听到了这首歌——感觉就像是自发产生的。理解这些情绪是回声——因为之前的习得而发生——可以帮助他们理解这些经历，并理解在逻辑的新大脑看来似乎完全安全的情况下，非常强烈的情绪是如何产生的。
关系框架理论
历史上，即使是激进的行为主义者也不得不承认他们的理论存在某些局限性——最显著的是在解释语言行为的细微差别方面（Törneke, 2010）。然而，过去几十年对行为主义者来说是激动人心的，因为这些局限性随着关系框架理论（RFT）的发展得到了解决（Hayes, Barnes-Holmes, & Roche, 2001; Törneke, 2010）。RFT可以很复杂，这里没有空间详细解释（而且我也没有资格这样做）。然而，这一理论对于理解威胁系统动态非常重要，因此我会尝试做一个简要的解释以适应当前的目的。
前面描述的所有学习形式——行为和后果之间以及同时呈现的不同刺激之间的习得联系——在动物和人类中都有观察到。然而，我们的象征思维能力使我们能够形成更为复杂的习得关系网络，即使这些事物在我们的实际经历中从未被联系在一起。例如，如果我教你A像B，B像C，你将得出A和C之间的新关系——得出A像C，C像A。这看起来很简单，但其意义重大——一旦得出，你就可以将这种关系投射到未来，考虑这对你的意义（例如，如果你认同A、B或C的某个方面）。你还可以形成大量其他衍生关系，例如，如果你之前学过B像Q，Q像P，P像R。然后你可以得出连接A和C与Q、P和R的关系，形成一个像蜘蛛网一样的心理联系网络——拉动一个点，整个网络都会移动。其他缺乏我们先进大脑的动物无法做到这一点。使用印刷字母的例子很难真正传达这些关系的实际意义，因此让我们考虑这种学习在我们的一位来访身上是如何表现的。
我们能够在心理上衍生不同关系的能力对理解我们如何处理威胁具有深远的影响。假设劳伦认为自己是女性，并且怀有一个成为成功科学家的梦想。她非常聪明，正在上学追求这个梦想。让我们想象一下，通过接触各种媒体和文化——比如电影、有线新闻频道、谈话等——她学会了将女性与软弱、无助或科学无能联系起来。或许在一个特别有力的学习经历中，她无意中听到一位男性权威人物对科学界的女性发表了恶毒的性别歧视言论，我们可以想象劳伦通过她自己作为女性的认同，推导出自己与无助或科学无能之间的联系。
鉴于她成为科学家的目标，劳伦会有什么感受？她对自己的目标和实现目标的能力会有怎样的感受？我们还可以想象，与女性相关的各种生活方面——她的着装方式、习惯行为、她喜欢的事物——都可能因这些衍生关系而受到影响——它们的效果（用RFT术语来说，即它们的刺激功能）发生了变化，使得这些反映她女性身份的事物不再是让她感到舒适的享受，而是触发她感到无助和软弱的信号，以及认为自己永远不可能成为一名合格的科学家。甚至劳伦的偏好现在也成了软弱的标志。
想象劳伦的故事
让我们想象劳伦非常渴望成为一名科学家，以至于她开始拒绝自己身上的这些方面，试图让自己变得更不像女性，从而有机会追求她的目标。她把裙子换成了裤子，改变了发型和颜色搭配。有一天，她在看有线新闻节目时，主持人恶毒地攻击了一位表现出男性化特征的女政治家——嘲笑她的外表，将她的果断称为“泼辣”，并诋毁她的性取向。我们可以想象，在劳伦的脑海中又形成了一组新的关系，其中她身上任何显得有些男性化的方面都被赋予了负面含义——她的行为、她的衣服，甚至是她进入传统男性领域的雄心壮志。劳伦怎么可能对自己的性别身份感到自在？她怎么可能对自己的目标感到自信？这位聪明的年轻女性完全现实的抱负，可能因为基于文化的谎言通过她脑海中的复杂关系网络而被摧毁。
这确实是一个复杂的问题，而我所描述的仅仅是关于RFT和人类言语行为细微差别的冰山一角。我不是建议给来访上关系框架理论的课。但我们可以通过帮助他们认识到，我们的大脑非常善于在脑海中链接和转换事物，使得在一次强烈的学习体验后，威胁感知几乎可以成倍地扩展到时间、情境、经历和思想中。这不是我们的错。这是大脑进化的结果，这种能力使我们作为一个物种能够完成惊人的事情，利用这些能力解决复杂的问题。关键在于帮助来访认识到，他们所挣扎的这些经历和感受是习得的，在他们生活的背景下及其进化的大脑工作方式中是有道理的，我们可以帮助他们以赋予力量、充满同情的方式应对这些挣扎。
社会学习
我们不仅可以通过直接经验学习，还可以通过观察他人来学习。我们可以通过观察他人遭受惩罚（例如，当他们发言时被嘲笑）来学习恐惧。我们可以通过观察他人的行为模式来学习行为（例如，父母在经历情绪时的行为，或者通过观看YouTube视频学习如何弹吉他）。通常在我们没有意识到的情况下，我们的大脑不断存储有关世界的信息，关于我们自己的信息，我们与他人的关系及其意义，以及我们应该如何度过一生的信息。帮助来访发现他们的生活如何被这些学习经历所塑造，可以为同情心的产生铺平道路——对自己和他人的同情。
在治疗过程中，这种探索不是通过机械地回顾某人的学习历史，使用大量技术术语（如上面介绍的一些术语）来进行的。而是通过围绕成长经历或创伤时期的话题进行有机的讨论。当来访向我们介绍他们的历史时——当我们构建对他们如何成为现在的理解时——我们可以以同情的方式（再次使用苏格拉底式的对话技巧）探讨他们是如何学会害怕某些事物或以特定方式做出反应的。通过这种方式，我们可以帮助他们形成一种同情的理解，即他们为什么会这样。让我们看看如何将一些内容带入治疗室：
治疗师：珍妮，我们一直在探讨引起你焦虑的一些情境，以及你从中学到了什么。在你被初中同学嘲笑的经历之后，你是否学会了害怕与同学建立关系或在课堂上发言？ 珍妮：是的，但是……（停顿，露出思考的表情。） 治疗师：看起来你还有些不确定…… 珍妮：是的，我初中时的经历确实帮助我理解了为什么我会在交友方面有问题。但我对很多其他情境也感到非常害怕，比如约会，我真的需要找份工作，但我无法去面试。 治疗师：所以还有一些情境似乎并不真的合乎逻辑——这些情境让你感到非常害怕，但似乎与你的过去经历无关。 珍妮：是的——这让我非常困惑。（左右摇摇头。） 治疗师：（点头）我能理解。让我们试着找出一些道理。 珍妮：那会很好。 治疗师：珍妮，你还记得我们谈论过大脑是如何非常狡猾的吗？就像佩内洛普或萨迪这样的动物不需要担心的事情？我们聊过的“新大脑/旧大脑”的内容？ 珍妮：是的。 治疗师：好吧，我们的大脑非常擅长将事物联系在一起——在不同的经历、想法和感受之间建立联系。我们的大脑进化出了这种能力——帮助我们快速理解世界，这样我们就可以了解事物如何运作，而不必亲身经历一切。 珍妮：嗯哼。 治疗师：但这也会对我们不利。如果我们在一个情境中经历了羞辱——比如在学校里是个新学生，在课堂上或走廊上被嘲笑——我们的大脑就会得出结论，认为在任何情境中成为焦点都是危险的。我们会在成为焦点和被排斥、羞辱之间建立联系。记住，我们的威胁系统非常努力地帮助我们识别威胁并保护自己——宁可安全也不要后悔。 珍妮：（点头） 治疗师：当我们经历了一次非常糟糕的经历时，我们可以将这种学习投射到未来，想象这种情况会一直如此。我们也可以将这种学习应用到很多不同的情境中——比如约会关系和求职面试。所以六年级的一次强烈学习经历可能导致我们的威胁系统在未来很长一段时间内被多种情境激活。特别是如果我们没有学会如何帮助自己感到安全的话。我们可能会发展出一个非常害怕各种情境的自我版本，认为避免这些情境是唯一保持安全的方法。这有道理吗？ 珍妮：当然有道理。这正是我的感受——我对这些情境感到非常害怕，甚至是一些我从未经历过的情境。我以为自己快疯了！ 治疗师：这确实会让人有这样的感觉，不是吗？但哪一种说法更有可能呢——你无缘无故地发疯了，还是你的威胁系统正在利用你学到的东西非常努力地保护你，确保你不再受到同样的伤害？（微笑） 珍妮：（微笑）好的，好的。我想我明白了。这更有道理。（停顿，低头看了一下） 治疗师：（沉默片刻） 珍妮：不过还是很糟糕。 治疗师：（稍作等待，然后温和地说）确实如此。这就是为什么我们要让你的安全系统去健身房锻炼，培养一个自信、智慧、善良、富有同情心的自我版本——帮助那个脆弱的部分感到安全。 珍妮：我很愿意那样做。
应对同情心的恐惧
在本章中，我们探讨了可能对来访造成问题的各种学习形式。正如我们所讨论的，CFT（同情聚焦疗法）的主要目标是帮助来访学会获得安全感——最初是通过治疗关系，随后是通过学会向自己施予同情，接受他人的同情，并建立和维持滋养的关系。连接很重要，因为我们主要是通过与他人的联结来感受到安全的——那些接受我们、喜欢我们并在我们需要时支持我们的人。
不幸的是，一些来访会将人际联结与威胁而不是安全感联系起来。通过创伤、虐待、困难的依恋历史或其他经历，我们的来访可能已经学到了关心他人或允许自己被关心是危险的。他们可能会积极抵制善意和同情，甚至觉得自己不配得到它。这给我们提出了一个根本的问题：如果本应帮助我们感到安全的联结（从进化的角度来看）反而与威胁联系在一起，我们如何才能感到安全？我们的一些来访可能会面临这个难题。即使他们有意识地想要建立联结并感到安全，强大的隐性学习经历也会让他们在真正开始联结时感到极大的威胁。你可能在来访身上有过类似的经历；就在治疗关系变得更为亲密，似乎来访应该感到更安全的时候，他们实际上却变得不稳定和不舒服。
我喜欢用一个比喻来说明这一点。在我家附近的华盛顿州斯波坎市有一家商店，出售价格非常合理的冷冻大虾。如果你临时需要举办聚会，只需买一袋，解冻后，混合一些辣根和番茄酱制成鸡尾酒酱，就有一个不错的开胃菜。但你需要提前计划，因为解冻说明非常具体：需在冰箱中过夜解冻。不要在流动水下强行解冻。事实证明，如果我们试图通过将冷冻虾放在流动水下来强行解冻，往往会引发边界干扰——虾会吸收过多的水分，变得软绵绵且难吃。
我认为人类很像这些虾。我们不能被强行解冻。当我们被冻结时——当我们学到了在与他人的联结中感到不安全并避免这种联结时——试图强行快速解冻会导致危险。我们很多人都有过这样的来访，我们试图强行解冻，过快地进入来访尚未准备好的阶段。在这种情况下，很容易出现关系破裂，给治疗带来障碍，甚至导致来访退出治疗。
我认为人类最好的“解冻”方式是置身于包含必要条件的环境中——这些条件使解冻成为可能——然后给予时间。对于这样的来访，我们说任何一句话都无法让他们的感情大脑得出“现在我可以感到安全”的结论。来访也可能对此感到沮丧（并且可能会从这个比喻中受益），因为他们可能有意识地知道在关系中感到安全对他们有益，并且迫切希望这样做。他们并不是选择在第一次接近时恐慌。他们甚至可能没有意识到发生了什么。他们学到了亲近是危险的，他们古老的感情大脑试图保护他们。这不是他们的错。
这就是为什么我认为我们采取的分层方法如此重要。我们可以将治疗师一致、温暖但不过度、充满同情的存在视为促进“解冻”的外部因素。这些感觉也可以从内部解冻，随着来访开始理解他们在关系中感到不安全的原因和方式，明白这不是他们的错，并致力于帮助自己应对这些问题。正念意识可以帮助来访识别他们在与他人联结时何时开始感到不安全，并暂停和观察而不是习惯性地退缩。最终，我们将在后面探讨的同情练习可以帮助来访主动培养温暖和联结的感觉，并在勇敢参与之前会避免的关系时，友好地指导和安慰自己。但我们需要有耐心，帮助来访对自己有耐心，认识到这种“解冻”是一个渐进的过程，不能强行加速。
总结
在CFT中，构成自我同情的基础层次之一是理解。正如我们在过去的几章中所看到的，来访得到了帮助，了解了他们的情绪和动机的来源，这些情绪和动机如何以强有力的方式组织心灵和身体，以及人们如何经常被他们既未选择也未设计的社会力量所塑造。正如上述临床例子所示，帮助来访理解他们的挑战是如何习得的，可以将这些挑战从“我有问题”转变为“我的大脑在应对它未曾设计的情境时试图保护我”。这也有助于消除对自身情绪的恐惧，因为他们开始理解这些体验不是来自外界的随机、不可控制的痛苦冲击，而是基于他们过去的生活经历的合理反应。在下一章中，我们将继续帮助来访与他们的思想、情绪和行为建立更有益的关系——探索正念作为一种方法，帮助来访以充满同情的意识对待这些体验。
本章知识点阐述
进一步阐述的知识点
1. 自我和社会塑造的关系
- 早期社会环境的影响：从出生起，我们的基因与早期社会环境相互作用，塑造了我们成为什么样的人。这些环境包括家庭、学校、社区等。
- 依恋理论：依恋理论解释了早期社会环境如何影响我们对他人和自己的基本理解，形成持久的依恋风格，进而影响我们的人际关系和安全感。
2. 依恋风格的分类
- 依恋安全感：源于与响应需求的养育照顾者的互动，安全个体能够自我安抚，有效应对威胁情绪，珍惜自己。
- 依恋焦虑：源于不可靠且反应不一致的抚养环境，焦虑个体渴望连接但不信任这种连接，难以自我安抚，对社会威胁高度敏感。
- 依恋回避：源于忽视或冷漠的抚养环境，回避个体倾向于避免亲密关系，独立性强，但可能缺乏情感深度和信任感。
3. 社会环境对个体发展的影响
- 早期依恋关系：安全的依恋关系有助于个体发展自我安抚能力和情绪调节策略，增强安全感。
- 社会支持：社会支持系统（如家庭、朋友、社区）对个体的心理健康和应对能力至关重要。
- 环境适应：个体在不同社会环境中学会适应，以满足基本需求，这些适应行为可能在日后成为习惯，影响个体的发展轨迹。
4. 治疗中的应用
- 探索依恋历史：通过探讨来访的依恋历史，帮助他们理解当前的行为和情绪反应的根源。
- 发展自我同情：帮助来访认识到他们感到羞耻的方面并非偶然形成，而是受多种社会因素影响的结果。
- 增强安全感：通过建立安全的治疗关系，帮助来访发展自我安抚和情绪调节能力，增强安全感。
总结
在CFT中，自我和他人同情始于认识到许多来访的挑战与他们无法选择或设计的因素有关。早期社会环境对个体的发展产生了深远的影响，通过依恋理论可以理解这些影响。安全的依恋关系有助于个体发展自我安抚能力和情绪调节策略，增强安全感。而依恋焦虑和依恋回避则可能导致个体在人际关系中遇到困难。通过探索来访的依恋历史，帮助他们发展自我同情，增强安全感，可以有效地促进心理健康和生活质量的提升。
进一步阐述的知识点
1. 依恋回避的特点
- 情感抑制：高依恋回避的个体倾向于抑制、压抑或避免情感体验。
- 人际距离：这些个体倾向于保持人际距离，独自行事，认为寻求支持有风险、不舒服或徒劳。
- 回避策略：他们采用疏远、否认和最小化情感的策略，这些策略会妨碍有效的应对。
2. 依恋回避的成因
- 不可靠的照顾者：通常由不可用或不响应的照顾者抚养长大，导致个体难以通过与他人的联系和支持来安抚自己。
- 家庭环境：家庭中的问题（如父母离婚、酗酒、忽视等）会影响个体的情感发展和依恋模式。
3. 治疗中的应用
- 理解情感：帮助来访理解他们的情感、动机和行为，以非指责、同情的方式。
- 非指责态度：强调这些经历不是来访的错，而是生活教给他们的。
- 安全感系统：通过建立安全的治疗关系，帮助来访发展自我安抚和情绪调节能力，增强安全感。
总结
在CFT中，治疗的重点不在于将人按依恋风格分类，而是帮助来访以非指责、同情的方式理解他们的情感、动机和行为。高依恋回避的个体由于不可靠的照顾者和家庭环境的影响，形成了抑制情感、保持人际距离和采用回避策略的习惯。通过理解这些经历，来访可以认识到这些情感和行为不是他们的错，而是生活教给他们的。治疗师通过建立安全的治疗关系，帮助来访发展自我安抚和情绪调节能力，增强安全感，从而改善他们的心理健康和生活质量。
进一步阐述的知识点
1. 学习理论与行为疗法的应用
- 广泛适用性：学习理论和行为疗法已被成功应用于理解和治疗各种情绪和行为问题。
- 与CFT的兼容性：CFT与这些方法非常兼容，治疗师应接受基本行为原则的培训，以更好地理解和治疗心理问题。
2. 行为的功能分析
- A-B-C模型：前因（Antecedent）、行为（Behavior）和后果（Consequence）。
- 前因的作用：外部刺激和内部体验，为行为的发生设置舞台。
- 后果的作用：强化或惩罚，影响行为未来发生的可能性。
3. 操作条件反射
- 正向强化：通过增加积极后果来增加行为的频率。
- 负向强化：通过去除不愉快的后果来增加行为的频率。
- 正向惩罚：通过增加不愉快的后果来减少行为的频率。
- 负向惩罚：通过去除积极后果来减少行为的频率。
4. 治疗中的应用
- 理解行为的合理性：帮助来访理解他们的行为在特定背景下是合理的，减少自我攻击。
- 同情的理解：通过同情的态度理解来访的行为，帮助他们找到更有帮助的策略。
- 价值观导向：帮助来访培养和加强一种以帮助自己感到安全为导向的同情自我，追求更高尚的目标。
总结
在CFT中，学习理论和行为疗法的应用帮助来访理解他们的行为在特定背景下是合理的，减少自我攻击。通过行为的功能分析，治疗师可以帮助来访识别行为的前因和后果，理解行为的合理性。操作条件反射的原理（如正向和负向强化、正向和负向惩罚）为理解行为的改变提供了科学依据。最终，通过同情的理解和价值观导向，帮助来访培养和加强一种以帮助自己感到安全为导向的同情自我，追求更高尚的目标，从而改善他们的心理健康和生活质量。
进一步阐述的知识点
1. 反应性条件反射（经典条件反射）
- 无条件刺激与无条件反应：某些刺激自然引发特定的反应，如车祸引发恐惧、性刺激引发性兴奋、与朋友共进晚餐引发安全感。
- 条件刺激与条件反应：通过与无条件刺激的多次配对，原本中性的刺激（如一首歌）也能引发类似的情感反应。
- 学习效率：进化使我们在某些情况下（如威胁和性）的学习效率更高，这有助于生存，但也可能导致过度敏感和不必要的恐惧反应。
2. 威胁系统的动态
- 情绪反应的合理性：帮助来访理解他们的情绪反应是在特定学习经历下的合理反应，减少自我攻击。
- 情感与认知的分离：逻辑的新大脑与情感的大脑之间可能存在脱节，导致来访难以理解自己的情绪反应。
- 习得的触发因素：某些触发因素（如特定的音乐）可能在无意识中引发强烈的情绪反应，即使当前情境本身并不危险。
3. 关系框架理论（RFT）
- 符号思维：人类的符号思维能力使我们能够形成复杂的习得关系网络，即使这些事物在实际经历中从未直接联系。
- 衍生关系：通过推导，我们可以在不同事物之间建立新的联系，这些联系可能对我们的认知和情绪产生深远影响。
- 威胁处理：RFT有助于理解我们如何处理威胁，特别是当某些身份特征（如性别）与负面特质（如无能）联系起来时，可能对个人的心理健康产生负面影响。
总结
反应性条件反射（经典条件反射）解释了如何通过与无条件刺激的配对，使中性刺激变成条件刺激，进而引发特定的情感反应。这一过程在进化上有助于生存，但也可能导致过度敏感和不必要的恐惧反应。理解这一过程有助于来访减少自我攻击，认识到他们的情绪反应是在特定学习经历下的合理反应。关系框架理论（RFT）进一步解释了人类如何通过符号思维形成复杂的习得关系网络，这些关系可能对我们的认知和情绪产生深远影响，特别是在处理威胁时。通过这些理论，治疗师可以帮助来访更好地理解自己的情绪反应，减少自我批评，找到更有效的应对策略。
进一步阐述的知识点
1. 劳伦的故事与文化影响
- 性别身份与职业抱负：劳伦的故事展示了性别身份如何影响职业抱负。文化中的性别刻板印象和负面言论可以深刻地影响个人的自我认知和职业选择。
- 衍生关系：通过观察和学习，劳伦将某些特征（如男性化）与负面评价联系起来，导致她在多个方面感到不安，包括行为、着装和职业目标。
2. 关系框架理论（RFT）
- 复杂的关系网络：RFT解释了人类如何通过符号思维形成复杂的习得关系网络，这些关系可能对认知和情绪产生深远影响。
- 文化和个人经历：文化中的刻板印象和个人经历可以通过复杂的心理网络相互作用，导致个体在多个方面感到威胁和不安。
3. 社会学习
- 观察学习：我们不仅通过直接经验学习，还可以通过观察他人的行为和经历来学习。例如，观察他人被惩罚可以让我们学会恐惧，观察他人的行为模式可以让我们学会如何行动。
- 潜移默化的影响：我们的大脑不断存储有关世界的各种信息，这些信息潜移默化地影响我们的认知和行为。
4. 治疗中的应用
- 同情的理解：治疗师通过帮助来访认识到他们的恐惧和反应是习得的，这些反应在他们生活的背景下是有道理的，从而帮助来访建立同情的理解。
- 新大脑与旧大脑：通过解释新大脑和旧大脑的功能，帮助来访理解大脑如何处理威胁信息，以及如何通过训练增强安全感。
- 苏格拉底式对话：通过提问和引导，帮助来访自我反思，逐步理解自己的情绪和行为模式，从而找到更有效的应对策略。
总结
劳伦的故事展示了性别身份和文化刻板印象如何影响个人的职业抱负和自我认知。关系框架理论（RFT）解释了人类如何通过符号思维形成复杂的习得关系网络，这些关系可能对认知和情绪产生深远影响。社会学习理论强调了观察学习的重要性，以及潜移默化的影响如何塑造我们的认知和行为。在治疗中，通过同情的理解、新大脑与旧大脑的解释以及苏格拉底式对话，可以帮助来访逐步理解自己的情绪和行为模式，从而找到更有效的应对策略，增强自我安全感。
进一步阐述的知识点
1. 应对同情心的恐惧
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CFT的目标
- 获得安全感：CFT的主要目标是帮助来访学会获得安全感，首先是通过治疗关系，然后是通过学会向自己施予同情，接受他人的同情，并建立和维持滋养的关系。
- 联结的重要性：人类主要通过与他人的联结来感受到安全，这种联结包括那些接受我们、喜欢我们并在我们需要时支持我们的人。
2. 创伤与联结
-
联结与威胁
- 负面联结：一些来访可能因创伤、虐待、困难的依恋历史或其他经历，将人际联结与威胁联系起来，认为关心他人或允许自己被关心是危险的。
- 隐性学习：这些来访可能已经学到了亲近是危险的，他们的感情大脑试图保护他们，即使他们有意识地想要建立联结并感到安全。
3. 解冻比喻
-
解冻过程
- 不能强行解冻：人类不能被强行解冻，就像冷冻虾不能在流动水下强行解冻一样。强行快速解冻会导致危险，包括关系破裂和来访退出治疗。
- 渐进过程：最好的“解冻”方式是置身于包含必要条件的环境中，并给予时间。来访需要在治疗师的一致、温暖但不过度、充满同情的存在下逐渐解冻。
4. 治疗中的应用
-
分层方法
- 外部因素：治疗师的一致、温暖但不过度、充满同情的存在是促进“解冻”的外部因素。
- 内部变化：正念意识和同情练习可以帮助来访识别和管理他们在关系中感到不安全的时刻，逐渐培养温暖和联结的感觉。
-
耐心与理解
- 治疗师的耐心：治疗师需要有耐心，帮助来访对自己有耐心，认识到“解冻”是一个渐进的过程，不能强行加速。
- 来访的理解：来访也需要理解这一过程，认识到他们的不安全感受是习得的，不是他们的错，而是大脑在保护他们。
总结
在CFT中，理解是构成自我同情的基础层次之一。通过帮助来访理解他们的情绪和动机的来源，以及这些情绪和动机如何以强有力的方式组织心灵和身体，可以将来访的挑战从“我有问题”转变为“我的大脑在应对它未曾设计的情境时试图保护我”。这有助于消除对自身情绪的恐惧，使来访认识到这些体验是基于他们过去的生活经历的合理反应。在治疗中，通过分层方法、正念意识和同情练习，可以帮助来访逐渐建立更有益的关系，培养温暖和联结的感觉。
CHAPTER 6 Compassionate Understanding: The Social Shaping of the Self
As we’ve discussed, compassion for self and others in CFT begins with the realization that many of our clients’ challenges have to do with factors they neither choose nor design. We explored the first piece of this in the past two chapters—the recognition that we have tricky brains shaped by evolu- tion to produce emotions that can be very difficult to manage. However, there is a second realiza- tion as well. From the moment of our birth, our evolved genetic potentials (genotypes) interact with and are shaped by another set of factors we don’t get to choose or design—our early social environments. As infants, we find ourselves entirely dependent upon caregivers who may or may not be equipped to nurture us and help us learn to manage these powerful emotions. We now know that different people are born with very different temperaments—more or less likely to experience emotions such as anxiety and irritability. These temperaments interact with our early social envi- ronments over time to shape the people that we will become. A growing body of research shows that these early environments powerfully impact our devel- oping brains, in particular those areas associated with emotion regulation and the processing of social information (Siegel, 2012; Cozolino, 2010). As we grow into childhood, adolescence, and early adulthood, we have growing influence over the contexts we inhabit, but are still shaped by social forces that can serve to model and reinforce habits that can cripple us later in life. Recognizing the ways in which we are shaped by social forces can support our clients’ development of self- compassion, as they realize that the aspects of themselves they feel most ashamed of did not develop by accident, and are not caused by some inherent flaw they possess.
DIFFERENT VERSIONS OF THE SELF If you attend very many CFT workshops, you’re likely to hear a story like the following: I was born into an educated, middle-class family with loving parents who were able to take care of me and provide me with the things I needed to survive and thrive—food, shelter, clothing, nurturing, and access to fun activities. They supported and encouraged my education, and taught me the skills I’d need to survive—how to study, manage my finances, and countless other things. But let’s imagine that instead, I was born to a single, drug-addicted mother in an impoverished inner-city slum. Let’s imagine that I often went hungry and alone, with no one to care for me when I needed help, abused by those who could have helped me. Let’s imagine that I had to learn to steal to feed myself, fight to protect myself, and sell drugs or commit other crimes to earn the money needed to live. Would the current version of me—the university professor, psychologist, and author—even be possible? Would it be likely? We all have basic needs, and we learn to produce behaviors that allow our needs to be met within the contexts in which we find ourselves—contexts we often don’t get to choose, but to which we have to adapt if we want to survive. The idea here is that we all represent only one version of what we could have become—a version that is defined by the unique pattern of interactions occurring between our life experiences and our genetic makeup. We, and all of our clients, were powerfully shaped by our early attachment relationships, as well as early and ongoing learning experiences. Considering these social forces can be a powerful step in helping our clients develop compassion for themselves and others. It can also help them take responsibility for working with their current social and physical environments, as they develop a growing awareness of how these environments can impact the course of their lives.
Attachment History and Attachment Style In the previous chapter, we explored how humans evolved to feel safe primarily in the context of connection with others who accept us and care about us (Gilbert, 2009a; 2010). John Bowlby and attachment researchers who followed him described how our early social environments can shape our most basic understandings of other people, and of ourselves in relation to others. In this way, early attachment histories give rise to relatively enduring attachment styles that shape how we will experience our relationships with others, and our ability to feel safe in the world. Different authors have used different methods for categorizing and labeling attachment styles. For our purposes, I’m going to discuss attachment in terms of three processes that can impact emotion regulation: attachment security, attachment anxiety, and attachment avoidance. Attachment security tends to result from interactions with nurturing caregivers who are responsive to our needs. Secure individuals learn that help is available if they need it, and develop a repertoire of effective emotion- regulation strategies they can draw upon (Mikulincer & Shaver, 2007). From a CFT perspective, secure attachment relationships prime the safeness system, laying down and strengthening the neural networks that facilitate individuals’ capacity for soothing themselves as they work effectively with threat-based emotions. Able to self-soothe, secure individuals can remain open to their emotions—acknowledging, feeling, and expressing them in adaptive ways (Mikulincer & Shaver, 2007). These individuals also learn to value themselves—their history of being cared for having taught them that they are worthy of caring and kindness.
Attachment anxiety tends to result from rearing environments that were unreliable and incon- sistently responsive to the child’s distress. Attachment anxiety is associated with desiring connec- tion but being unable to trust that it will be there when needed, or fearing that it can disappear unpredictably. Hence, such individuals may find themselves unable to feel soothed even when social nurturing or connection is present. Clients with high levels of attachment anxiety may expe- rience threat emotions in exaggerated, very intense ways—perhaps implicitly shaped by caregivers who provided nurturing only when the child displayed extreme levels of distress (Mikulincer & Shaver, 2007). Struggling to self-soothe or regulate their emotions, these individuals may seem to live in the threat system, ruminating on perceived threats, and hypersensitive to signs of social threat. They tend to be interested in others, but have difficulty managing relationships, and may be terrified of rejection.
In contrast, individuals high in attachment avoidance employ lots of strategies to inhibit, sup- press, or avoid their emotional experiences. Often raised by unavailable or unresponsive caregivers, avoidant individuals can tend toward interpersonal distance and “going it alone,” and may see support-seeking as risky, uncomfortable, or futile. Unable to soothe themselves through feelings of connection and support, these individuals turn instead to avoidance strategies— distancing, denying, and minimizing their emotions. These strategies can get in the way of effective coping, as clients avoid rather than engaging in problem solving, seeking support, or reappraising their situa- tion in more helpful ways (Mikulincer & Shaver, 2007). Like anxious individuals, from the CFT perspective, avoidant folk are seen to have underdeveloped safeness systems to draw upon in soothing themselves and working with their emotions, instead relying upon threat-based avoidance strategies (called safety strategies), which often have crippling long-term consequences. Our clients don’t get to choose whether they feel safe in relationships with others, whether they feel confident in dealing with emotions, and whether they experience themselves as con- nected, vulnerable, or isolated. If these were choices, of course we’d all choose to feel safe, confi- dent, and connected. We can’t change the past, but we can help our clients begin to understand how they came to be this way, and that these experiences are not their fault: Therapist: Jenny, in our last session we talked a bit about how we come to feel either threatened or safe, and how these experiences organize the mind—how we pay attention, experience emotions, think, and so on… Jenny: Yes, I remember. Therapist: Excellent. In CFT, we also consider how people learn to feel either safe or threatened—and a lot of times, this relates to our history of relationships with other people. We’ve talked about this before a bit—how you learned to feel unsafe in social situations after that terrible experience you had with the other girls in middle school. Jenny: That’s right. That was awful. It made me terrified of being around other people. Therapist: It made it hard for you to risk trusting others, and scared of having relationships? Jenny: It’s almost impossible. Therapist: When that happened—when you moved to the new school, and the other girls were so mean to you—did you talk with anyone about it? Jenny: I tried to talk with my mother, but she didn’t really help. I mean, she tried, but I don’t think she understood. She told me that girls were just like that sometimes, and that I shouldn’t make such a big deal out of it. Therapist: So she wasn’t really able to help you? Jenny: Well, she wasn’t doing too well herself. She and my father had just divorced, and their marriage had been bad for a while. It was really ugly. He had cheated on her, and she’d been doing a lot of drinking. It was bad enough that we moved after the divorce. Therapist: So her life was enough of a mess that she had a hard time being there for you? Jenny: Yes. I mean, she tried. She really did. It’s like she could tell that she wasn’t really doing a good job as a parent. She even said that sometimes, and she’d try to make up for it. She’d buy me stuff—expensive jeans, that sort of thing. But most of the time… (Shakes her head and sighs.) Therapist: Most of the time? Jenny: Most of the time she just didn’t have it together. When Dad was there, she seemed unhappy, and after we moved, she just… (Pauses.) She was never mean to me. She just seemed caught up with her own stuff most of the time. Therapist: How about your dad? Jenny: He was kind of your absent father. He mostly seemed to be away a lot—working a lot, or whatever he was doing. Therapist: Did you have much of a relationship with him when he was around? Do you remember doing things with him? Jenny: I loved spending time with him, but he just wasn’t there much. And after the divorce, he said he wanted to have a relationship with me, but he never really followed through. He’d call and schedule a time to pick me up for the weekend, but half the time he wouldn’t show. After a while he just sort of stopped calling. I guess he was more interested in his new family. (Looks down, a bit tearful.) Therapist: (Waits in silence.) Jenny: (Sighs.) I guess I had some crappy parents, huh? Therapist: It does sound like they had a lot of their own stuff going on, which got in the way of being there for you. Remember how we talked about the safeness system, and how we tend to feel safe through our connections with others who care about us? As we think about all of this, does it make sense that you might have a hard time feeling safe in relationships—have a hard time trusting that others will be there when you need them? Jenny: It does make sense. Therapist: Instead of learning that you could rely on others for help when you needed it, you learned that sometimes they’d be there, and… Jenny: And a lot of the time they wouldn’t. Therapist: Jenny, given this learning, do you think it’s your fault that you feel unsafe in relationships? Is it your fault that you have trouble trusting others to be there when you need them, or is that something your life has taught you? Is that your fault? Jenny: No, it’s not my fault. Therapist: (Pauses for a bit.) Could you say that again? Jenny: (crying) It’s not my fault. As the vignette above demonstrates, in CFT, the focus isn’t upon categorizing people in terms of attachment style, but on helping our clients understand their emotions, motivations, and behav- iors in nonshaming, compassionate ways. There are lots of ways clients can learn to feel unsafe, or develop habits that don’t fit with the lives they’d like to have. Let’s explore a few more.
Learning Theory and Behavior Therapy Learning theory and behavior therapy have been successfully applied to the understanding and treatment of a wide variety of emotional and behavioral problems. CFT is quite compatible with these approaches, and optimally, a CFT therapist will have received training in basic behavioral principles and how they apply to understanding and treating psychological problems. Although behaviorists and behaviorism aren’t always thought of as warm and compassionate, if we look closely, we see that behavioral understandings inherently undermine shame and self-attacking at their core. They help us, and our clients, clearly understand how their problems were learned, and how these challenges make complete sense when we consider the contexts in which they occur. Recognizing these challenges as learned rather than as something that is inherently wrong with me can help our clients have compassion for themselves (It’s not my fault that I have these struggles), and can give us direction as we compassionately work to address them. There are many excellent resources on learning theory and behavior therapy, so I won’t go into detail here, but I did want to briefly mention some methods of learning and ways we can bring such understandings into CFT.
OPERANT CONDITIONING AND FUNCTIONAL ANALYSIS OF BEHAVIOR A functional analysis of behavior can be very useful as we help clients answer the question, Why do I do this stuff? Conducting a functional analysis involves figuring out the factors that control the occurrence of a given behavior—what factors set the stage for the behavior to occur, and what consequences follow it. This process is often communicated using the acronym A-B-C, which stands for antecedent, behavior, and consequence. When doing a functional analysis, we start by selecting a specific behavior. This could be something observable that the client does, or private behavior such as thinking (for example, self-attacking or rumination).
Once we’ve figured out the behavior we’re interested in, we look for antecedents to the behavior—factors that precede it and signal its likely occurrence. Antecedents can be external factors (stimuli) that signal the presence of a punisher or reward, triggering the occurrence of related behaviors (called discriminative stimuli, because they allow us to detect or discriminate the presence of threats and rewards). Antecedents can also be internal experiences that aren’t related to the avail- ability of things the individual does or doesn’t like, but instead involve motivational states that “set the stage” for certain behaviors to occur, impacting whether or not a behavior is likely to have pleasing or displeasing consequences. Hunger is a good example. We can see how this works: Regardless of the general availability of food, eating is much more rewarding to us when we are hungry. In this way, antecedents can either let us know that a reward is available (serving a discrimi- native function) or motivate us to go looking for one (serving a motivational function) (Törneke, 2010). Key is the understanding that antecedents orient us to the potential that desirable or unde- sirable consequences will follow our behavior, setting the stage for these behaviors to occur. Once we’ve specified the behavior we’re interested in and the antecedents that precede it, we can explore the consequences that follow the behavior and impact its likelihood of occurring in the future. Some consequences are reinforcing, increasing the likelihood that a behavior will be repeated. This can be either because the consequence is something the individual prefers, such as receiving a good grade after studying for an exam (positive reinforcement), or because it involves the termination or removal of an experience that the individual dislikes—like medication getting rid of a headache (negative reinforcement).
Other consequences, called punishers, decrease the likelihood of behaviors being repeated. This can occur because the consequence of the behavior is aversive and nonpreferred (called punish- ment or positive punishment—where positive refers to the addition of the undesirable consequence), such as being laughed at after attempting to answer a question. Punishment can also occur when conse- quences involve the termination or removal of something the individual prefers, as in having friends pull away and distance themselves from you after you tell an offensive joke. This is sometimes referred to as negative punishment—where negative refers to the removal of the preferred state or situa- tion—or response cost (as in, the behavior or response has a cost).
Conducting a functional analysis with our clients can assist them in understanding how the behaviors they engage in—of which they may feel very ashamed and self-critical—actually make sense when we consider them in context. The prison inmate’s aggression makes a whole lot more sense when we see that he has always lived in dangerous environments, and that being aggressive meant that others would leave him alone rather than target him for victimization.
Chris: After I almost killed that guy, the others left me alone. I guess they decided it wasn’t worth it—and that was fine by me. They knew I could go off at any time. They knew that if you fucked with me, you would get hurt, and hurt bad. Therapist: It sounds like you learned to be violent in the effort to feel safe—that if you were tough enough, people would leave you alone—and it worked. If we think of it like this, does it make sense that you would learn to be violent, to keep up that image? Chris: It sure does. But that’s not who I want to be. That’s not the dad I want my son to have. Therapist: So that violent version of you served his purpose, but we don’t want to leave him in charge. How about we work to develop another version of you that fits with the sort of dad you want to be? Chris: Sounds good.
Likewise, when we recognize that our client’s cutting has provided her with temporary relief from terrible emotional pain, we can compassionately understand why she may be reluctant to give this strategy up. Both of these clients may experience intense shame and self-criticism as they observe themselves struggling to stop performing behaviors that create great problems for them and don’t fit with who they want to be, but which serve (or served) a very real purpose in their lives. This shame and self-criticism can paradoxically keep them stuck in the threat system and potentially prevent them from taking responsibility for changing the behavior, as they work to avoid shame-related discomfort by blaming others, rationalizing their behavior, or simply shifting their attention elsewhere. We see these themes occurring again and again, in clients who struggle with the very behaviors that their lives shaped in them—behaviors they developed in the effort to meet their needs and keep themselves safe. Helping clients understand how these behaviors make sense given their histories can help shift the focus away from self-attacking and toward compassion- ately finding more helpful strategies for pursuing these very admirable goals—keeping themselves safe and working with their suffering.
In the language of CFT, we find that many of our clients seem to live in the threat system— with their lives and behaviors centered on efforts to reduce or avoid uncomfortable experiences. This is what behaviorists sometimes refer to as behavior being “under aversive control” (Skinner, 1953), and which Buddhists refer to when they talk about aversion. In CFT, we help clients learn to not just reduce experiences of threat and discomfort, but to cultivate and strengthen a compassion- ate version of the self that is oriented toward helping themselves feel safe (undermining the aversive control), exploring what will be helpful in addressing their challenges (versus merely trying to avoid or escape unwanted emotions related to those challenges), and moving toward the way they want their lives to be (versus away from how they don’t want it to be). In this way, we see that CFT has much in common with approaches like ACT—which heavily emphasizes values work—and DBT, in emphasizing the development of adaptive skills like distress tolerance and emotion- regulation skills.
RESPONDENT CONDITIONING In addition to learning connections between antecedents, behavior, and consequences, our brains are also highly efficient at learning connections between different stimuli. Certain stimuli— events, experiences, things in our environment, even ideas or mental imagery—have the natural capacity to produce certain responses in us. We can consider this process for each of the three emotion-regulation systems we discussed in the previous chapter (threat, drive, and safeness). For example, being in a life-threatening situation such as a car accident can naturally produce fear. Sexual stimulation can naturally lead to sexual arousal. Warm conversations with dear friends over dinner can lead to feelings of comfort and safeness. Let’s imagine three different people, one in each of these situations—a terrifying car wreck, a heated bout of passionate lovemaking, and a warm dinner with a dear one. Since each of these situations naturally produces a response, we call them unconditioned (unlearned) stimuli, and the responses that result from them (fear, sexual arousal, safeness), by virtue of arising naturally in response to the stimuli, are called unconditioned (unlearned) responses.
Let’s imagine that in each of these situations, the same song is playing on the radio in the back- ground. Our brains are very efficient at linking things together, so for each of these people, this song can become associated with the situation (car wreck, sex, warm interactions with dear friends). In the future, these individuals could come to have very different learned reactions to this song, through its connection with the situations. The individual in the car wreck hears the song and experiences a rush of fear. The lover hears it and feels a rising of sexual feelings. The friend hears it and feels a warm arising of safeness and peace. The form (what it is) of this stimulus—the song—is the same for each of these individuals, but its function (its effect—what it does) is entirely different, due to its previous pairing with these different situations. In each case, the individual has learned to have an emotional response to the song, which now functions as a conditioned (learned) stimu- lus in its ability to provoke conditioned (learned) responses—fear, sexual arousal, or safeness. This learning process is an example of respondent conditioning (also known as classical conditioning). It’s worth mentioning that evolution has shaped us so that not all learning is created equal— some types of learning, sometimes called prepared learning, had much more survival value for our ancestors, and so we adapted such mental connections much more quickly and efficiently. In the case of powerful threat emotions like fear or disgust, for example, we can learn such connections in a single trial—so even after only one car accident, the survivor may experience extreme fear when he next hears that song. In the case of the sexual situation, it may take a few such spicy encounters before the song acquires the ability to trigger sexual feelings on its own (particularly if the song is also heard at other times). We might need an entire summer of barbecues with good friends at the lake before the song strongly brings up feelings of safeness. In particular, our brains are biased toward processing threat—which is why it can be easy for clients to learn to feel threatened in response to a variety of situations and triggers, and more difficult for them to learn to feel safe, particularly when their early environments didn’t often provide them with experiences of safeness. Many clients will report overwhelming emotions in response to what seem to be relatively minor situations, or even occurring “out of the blue,” in which powerful feelings of fear, anger, or sadness arise in them with no warning or explanation. These experiences can be terrifying, poten- tially leading clients to fear their own emotions as powerful, unpredictable forces capable of striking at any time, with the clients feeling “crazy,” vulnerable, and helpless in the face of these feelings. We can imagine how such experiences might lead clients to find their own emotions threatening, and strive to avoid them. Such experiences can also prompt self-criticism in our clients, as they observe there’s no reason for me to feel this way…there must be something wrong with me. The logical new brain often can’t see or understand what the old, emotional brain is responding to, so it blames the victim. Here again, we can help our clients explore how they learned these emotional responses, and how, given these learning experiences, their emotional responses and related motives (for example, desires to escape or avoid situations that trigger the emotions) make complete sense. There’s nothing wrong with them—they simply have tricky brains that are working very hard to keep them safe, by identifying every possible signal they’ve previously learned to connect with danger—even when these signals (like our song) aren’t at all dangerous. Often, our clients won’t even be aware that they’ve heard the song at all—the feelings just seem to come up on their own. Understanding that these emotions are echoes—occurring because of previous learning—can help them to make sense of these experiences, and to understand how very powerful emotions can arise even when the situ- ation seems perfectly safe to our logical new brains.
RELATIONAL FRAME THEORY Historically, even radical behaviorists have occasionally had to admit that their theories had certain limitations—most notably in explaining the nuances of verbal behavior (Törneke, 2010). However, the last few decades have been exciting ones for behaviorists, as these limitations have been addressed with the development of relational frame theory, or RFT (Hayes, Barnes-Holmes, & Roche, 2001; Törneke, 2010). RFT can be complicated, and we don’t have space to explain it well here (and I’m not qualified to do so). However, this theory is important enough for understanding threat system dynamics that I’ll attempt a brief explanation to suit our current purposes. All of the previously described forms of learning—learned connections between behaviors and consequences and between different stimuli presented at the same time—are observed in animals as well as humans. However, our ability for symbolic thought allows us to form much more complex networks of learned relationships, even between things that have never been linked together in our actual experience. For example, if I teach you that A is like B, and B is like C, you will derive a new relationship between A and C—concluding that A is like C, and that C is like A. This may seem simple, but its implications are significant—once derived, you can then project this relationship into the future and consider what that means for you (if, for example, you identify with something about A, B, or C). You can also form loads of other derived relationships, if, for example, you’ve previously learned that B is like Q, which is like P, which is like R. You can then derive relationships linking A and C with Q, P, and R, multiplying across a network of mental connections like a spiderweb—tug one point, and the whole web shifts. These are things that other animals, lacking our fancy new brains, just can’t do. It’s hard to get the real significance of these relationships by using an example that features printed letters, so let’s consider how this learning might play out in one of our clients. The implications of our ability to mentally derive different relationships can be harrowing for understanding how we process threat. Suppose Lauren considers herself to be feminine, and that she has harbored a dream of becoming a successful scientist. She is quite intelligent and is attend- ing school in pursuit of this dream. Let’s imagine that through her exposure to various media and culture—say, movies, cable news channels, conversations, that sort of thing—she learns to connect femininity with weakness, helplessness, or incompetence at science. Perhaps punctuated by a par- ticularly powerful learning experience in which she overhears a male authority figure making a nasty gender-based slur about women in the sciences, we can imagine Lauren deriving a connec- tion between herself (via her own experience of identifying as feminine) and helplessness or scien- tific incompetence.
Given her goal of becoming a scientist, how would Lauren feel? How might she feel about her goals and her ability to attain them? We can also imagine how the various aspects of her life that are linked with femininity—the way she dresses, habitual behaviors, the things she likes—can be tainted by these derived relationships—their effects (in RFT lingo, their stimulus functions) trans- formed so that instead of being things she enjoys that help her feel comfortable, these reflections of her femininity are now triggers for feeling helpless and weak, and thinking that she’ll never be a competent scientist. Even Lauren’s preferences are now signs of weakness.
Let’s imagine that Lauren wants to be a scientist so badly that she begins to reject these aspects of herself, in the effort to become less feminine and have a chance at pursuing her goal. She exchanges her dresses for pants, changes her hairstyle and her color palette. And then, one day, she’s watching a cable news program in which the hosts are viciously attacking a female politician for appearing masculine—ridiculing her appearance, labeling her assertiveness as “bitchy,” and derid- ing her sexuality. We can imagine another set of relationships being derived in Lauren’s mind, in which everything about her that seems in any way masculine is now tainted with negative implications—her behavior, her clothes, even her ambitions to enter a stereotypically male field. How is Lauren ever to feel comfortable with her gender identity? How can she feel comfortable and confident in pursuing her goals? This brilliant young woman’s completely realistic aspirations can be crushed, all due to culturally based lies being multiplied through a complex network of derived relationships in her mind.
This is tricky business indeed, and what I’ve described is really just the tip of the iceberg when it comes to RFT and the nuances of verbal behavior in humans. I’m not suggesting that we give our clients lessons in relational frame theory. But we can help them recognize that our brains are very good at linking and translating things in our minds so that given a powerful learning experience, perceptions of threat can be magnified and multiplied almost exponentially across time, situations, experiences, and thought. This is not our fault. It is a result of the evolution of our brains, and it’s a capacity that has allowed us to do amazing things as a species, as we use these abilities to solve complex problems. Again, the key is to help clients recognize that these experiences and feelings they struggle so greatly with are learned, that they make sense in the context of their lives and the way their evolved brains work, and that we can help them work with these struggles in empowering, compassionate ways.
WORKING WITH FEARS OF COMPASSION In this chapter, we’ve explored various forms of learning that can be problematic for our clients. As we’ve discussed, a primary goal of CFT is to help clients learn to access feelings of safeness— initially through the therapeutic relationship, and in going forward, through learning to direct compassion to themselves, to receive it from others, and to form and maintain nurturing relationships. Connection is important, as we evolved primarily to feel safe through affiliation with others—others who accept us, who like us, and who can support us when we need it. Unfortunately, some clients will have learned to associate interpersonal connection with threat rather than safeness. Through trauma, abuse, difficult attachment history, or other experiences, our clients may have learned that to care about others or to allow themselves to be cared about is dangerous. They may actively resist kindness and compassion, even feeling as if they don’t deserve it. This presents us with a fundamental question: If the connections that are supposed to help us feel safe (evolu- tionarily speaking) instead become associated with threat, how do we ever feel safe? Some of our clients will present with exactly this conundrum. Even if they consciously want to build connections and feel safe, powerful implicit learning experiences lead them to feel really threatened as soon as they start to really connect. You’ve probably had experiences like this with clients; just as the therapeutic rela- tionship is getting closer and it seems like the client should be feeling safer, they actually become destabilized and uncomfortable. I like to talk about this using a metaphor. A store near my home in Spokane, Washington, sells bags of nice big frozen prawns at a very reasonable price. They’re great if you’re having a last- minute get-together—just pick up a bag, thaw them out, whip together some horseradish and catsup to make cocktail sauce, and you’ve got a nice hors d’oeuvre. But you’ve got to plan ahead, as the thawing instructions are very specific: Thaw in the refrigerator overnight. Do not force-thaw under running water. It turns out that if we attempt to force-thaw the frozen shrimp by placing them under running water, it will often create a boundary disturbance—the shrimp will absorb way too much water, and become mushy and gross. I think humans are a lot like these prawns. We can’t be force-thawed. When we’re frozen— when we’ve learned to feel unsafe in connection with others and to avoid such connection— attempts at forcing us to thaw too quickly can lead to peril. Many of us have had clients that we tried to force-thaw, moving too quickly to places the client wasn’t yet ready to go. In such situa- tions, it’s easy to have relationship ruptures that create obstacles in the therapy, or even to have clients drop out of treatment. I think the best way for us humans to “thaw” is to place ourselves in an environment that con- tains the necessary conditions—the causes and conditions that make thawing possible—and then to give it some time. With clients like this, there’s no one thing we can say that will lead their emo- tional brains to conclude, Oh, I can go ahead and feel safe, now. Our clients may be frustrated by this, too (and may benefit from hearing the metaphor), as they may consciously know that they’d benefit from feeling safe in relationships, and may desperately want to do so. They’re not choosing to panic at the first sign of closeness. They may not even recognize what is happening. They’ve learned that closeness is dangerous, and their old, emotional brains are trying to protect them. It’s not their fault. This is why I think the layered approach we’re taking is so important. We can think of the con- sistent, warm-but-not-overwhelming, compassionate presence of the therapist as an external factor that facilitates “thawing.” These feelings can be thawed from the inside as well, softened as clients begin to understand how and why they feel unsafe in relationships, that this isn’t their fault, and commit to helping themselves work with this. Mindful awareness can help clients identify when they begin to feel unsafe in connection with others, and to pause and observe rather than habitually pull back. Finally, the compassion practices we’ll explore later can help clients begin to actively cultivate feelings of warmth and connection, and to kindly coach and reassure themselves as they courageously participate in relationships they would have previously avoided. But we need to have patience and help clients have patience with themselves, recognizing that this thawing is something that happens over time. It can’t be forced.
SUMMARY In CFT, one of the foundational layers underlying self-compassion is composed of understanding. As we’ve seen in the past few chapters, clients are helped to understand where their emotions and motives come from, how they organize the mind and body in powerful ways, and how people are often shaped by social forces that they neither choose nor design. As we see in the clinical example above, helping clients understand how their challenges were learned can help shift their under- standing of these challenges from something that is wrong with me to my brain working to protect me in situations that it wasn’t designed to deal with. It can also help undermine fears of their own emotions, as they come to understand these experiences not as random, uncontrollable jolts of pain from out of nowhere, but as understandable reactions that make sense given their previous life experience. In the next chapter, we’ll continue the work of helping our clients develop a more helpful relationship with their thoughts, emotions, and behavior—exploring mindfulness as a method to help clients relate to these experiences with compassionate awareness.