引言

Introduction And a woman spoke, saying, “Tell us of Pain.” And he said: Your pain is the breaking of the shell that encloses your understanding. Even as the stone of the fruit must break, that its heart may stand in the sun, so must you know pain. And could you keep your heart in wonder at the daily miracles of your life, your pain would not seem less wondrous than your joy; And you would accept the seasons of your heart, even as you have always accepted the seasons that pass over your fields. And you would watch with serenity through the winters of your grief. From The Prophet, by Kahlil Gibran Compassion involves allowing ourselves to be moved by suffering, and experiencing the motivation to help alleviate and prevent it. Compassion is born of the recognition that deep down, we all just want to be happy and don’t want to suffer. In this book, you’ll learn about compassion-­focused therapy (CFT), a therapy that focuses on the purposeful cultivation of compassion, the skills and strengths that flow from it, and how to use these to work effectively with human suffering. When we see what we’re up against—­the situation we’re all in together, just by the virtue of having human lives—­there’s a deep realization that can arise: With all the potential suffering and struggle that we and all humans will face, compassion is the only response that makes sense. Why do we need compassion? We need compassion because life is hard. Even if we’re born into a relatively advantaged existence, with ready access to food, a comfortable place to live, people who love us, education, and opportunities to pursue our goals—­even if we have all of this—­we will all face tremendous pain in our lives. We’ll all get sick, grow old, and die. We’ll all lose people we love. We’ll all sometimes do our very best in pursuit of goals we desperately desire, and fail. Most of us will have our hearts broken, if not once, then several times. To have a human life means we will face pain. It’s the price of admission. Life is hard, for everyone. But we can forget this. We can forget that all of us hurt, and that these feelings are universal—­ part of what binds us together as human beings. Many of us, and many of those we seek to help, can instead experience these struggles and emotions as isolating, as signs that there is something wrong with me. Instead of reaching out for help, we may pull back from others. Instead of supporting, encouraging, and reassuring ourselves, we may meet our struggles with criticism, attacks, and shame. And even when we know better, it can be hard for us to feel reassured. This business of being human can be tricky indeed. And for some people—­such as the psychotherapy clients we seek to help—­things are exponentially more difficult.

COMPASSION-­FOCUSED THERAPY It was observations like these that inspired my dear friend and colleague Paul Gilbert to develop compassion-­focused therapy. CFT was designed to assist therapists in helping clients understand their mental suffering in nonshaming ways, and to give them effective ways to work with this suf- fering. Over the last few years, CFT has been increasingly used by mental health providers—­first in the United Kingdom where it was developed, and increasingly in other parts of the world as well. It’s also been the focus of a growing body of empirical work.

What Is CFT and How Is It Useful? CFT represents the integration of various science-­based approaches for understanding the human condition with mind-­training practices that are literally thousands of years old. Finding its scientific footing in evolutionary psychology, affective neuroscience (particularly the neuroscience of affiliation), the science of attachment, behaviorism and cognitive behavioral therapy (CBT), and the growing body of literature supporting the efficacy of mindfulness and compassion practices, CFT is focused on helping clients relate to their difficulties in compassionate ways and on giving them effective methods for working with challenging emotions and situations. CFT was originally developed for use with patients who have a tendency toward shame and self-­criticism, who may struggle in treatment even while engaging in evidence-­based therapeutic protocols such as CBT (Gilbert, 2009a; Rector et al., 2000). For example, such patients may be able to generate thoughts such as I know that what happened wasn’t my fault, but struggle to feel reassured by such thoughts. A focus of CFT is to create an emotional congruence between what clients think (for example, helpful thoughts) and what they feel (for example, reassured). CFT helps patients learn to engage with their struggles and those of others in warm, accepting, and encouraging ways, to help themselves feel safe and confident in working with challenging affects and life difficulties. CFT has been applied to a growing list of problems including depression (Gilbert, 2009a; Gilbert, 2009b), psychosis (Braehler et al., 2013), binge-­eating disorder (Kelly & Carter, 2014; Goss, 2011), anxiety (Tirch, 2012), anger (Kolts, 2012), trauma (Lee & James, 2011), social anxiety (Henderson, 2010), and personality disorders (Lucre & Corten, 2013).

The CFT Approach A growing body of empirical research supports the potential use of compassion interventions in psychotherapy (Hofmann, Grossman, & Hinton, 2011). One thing that distinguishes CFT from other therapies that incorporate compassion is our focus on helping clients understand their chal- lenges in the context of evolution (how our brains evolved to produce basic motives and emotions), the dynamics of how emotions play out in the brain, and the social factors that shape the self, par- ticularly early in life. None of these factors are chosen or designed by our clients, but they play a huge role in their struggles. In this book, you’ll learn to help clients apply these understandings to their problems, so that they can stop shaming and attacking themselves for things that aren’t their fault, and focus on taking responsibility for building better lives. Whereas shame is linked with avoidance that can contribute to our clients’ struggles (Carvalho, Dinis, Pinto-­ Gouveia, & Estanqueiro, 2013), compassion can give them a way to approach their difficulties with acceptance and warmth, to face them and work with them. In CFT, clients learn about how different emotions and basic motives evolved to serve certain functions, exploring how these emotions play out in ways that can create interesting challenges when combined with modern environments and new-brain capacities for imagery, meaning-­making, and symbolic thought. For example, clients learn how the confusing dynamics of threat emotions like anxiety and anger make complete sense when viewed through the lens of evolution. Such understanding reveals why it’s so easy to get “stuck” in such emotions, which can help lessen clients’ tendencies to shame themselves for their feelings. CFT also explores how social contexts and attachment relationships can serve to transform our underlying genetic potential into challeng- ing behaviors and emotions. This exploration creates a context for self-­compassion to take root, as patients begin to realize how many of the factors that create and maintain their problems were not of their choice or design, and hence, not their fault. In CFT, this de-­shaming process is accompanied by a simultaneous building of responsibility and emotional courage through the cultivation of compassion. Patients learn to work with evolved emotion-­regulation systems to help themselves feel safe and confident as they approach and actively engage with life challenges. They are guided in developing adaptive, compassionate strategies for working with emotions, relationships, and difficult life situations. In CFT, the emphasis is on helping clients learn to stop blaming themselves for things they didn’t get to choose or design, and to skill- fully work with the factors they can impact to build a repertoire of skills for working with life chal- lenges and building fulfilling, meaningful lives. As we will explore, this is done through both implicit aspects of the therapy, such as the therapeutic relationship and the therapeutic emphasis upon guided discovery, as well as specific techniques such as imagery, compassion cultivation practices, and the development of compassionate reasoning.

The Evidence Base for CFT One of the most important movements in the field of mental health over the past century or so is the emphasis on having our treatments grounded in solid science. The evidence base in support of CFT is twofold: First, there is the growing body of research supporting the efficacy of CFT interventions. Second, there are several underlying bodies of literature that provide the scientific basis for the theory behind CFT as well as the process-­level components of the therapy. While the focus of this book is on learning the therapy, I wanted to take a moment to briefly introduce you to the science underlying CFT.

EVIDENCE FOR CFT INTERVENTIONS Of course, the first question to consider is Does CFT work? There is a relatively small but rapidly growing body of research documenting the efficacy of CFT interventions. Research has shown that CFT can help to reduce self-­criticism, shame, stress, depression, and anxiety (Gilbert & Proctor, 2006; Judge, Cleghorn, McEwan, & Gilbert, 2012). Other studies have documented posi- tive outcomes using CFT with people suffering from psychotic disorders (Braehler et al., 2013; Laithwaite et al., 2009), eating disorders (Kelly & Carter, 2014; Gale, Gilbert, Read, & Goss, 2014), personality disorders (Lucre & Corten, 2013), problematic anger (Kolts, 2013), and traumatic brain injury (Ashworth, Gracey, & Gilbert, 2011), and in conjunction with eye movement desensitization and reprocessing for the treatment of trauma (Beaumont & Hollins Martin, 2013). The primary limitation of the current literature supporting the efficacy of CFT is the relative lack of randomized controlled trials (RCTs) documenting its effectiveness. At the time of this writing, there are two such RCTs in print. One of these (Kelly & Carter, 2014) showed significant impacts of CFT in reducing binges, global eating disorder pathology, and eating and weight con- cerns, and increasing self-­ compassion in individuals with binge-­ eating disorder. The second (Braehler et al., 2013), documented the impact of CFT upon clinical improvement in patients suf- fering from psychosis relative to controls, along with increases in compassion that were associated with reductions in depression and perceived social marginalization. A recent systematic review of the literature on CFT (Leaviss & Uttley, 2014) concluded that CFT shows promise in treating psy- chological disorders, particularly for highly self-­critical individuals, but notes that more high-­ quality clinical trials are needed before definitive statements can be made about CFT being an evidence-­based treatment approach. We in the CFT community agree with this assessment, believ- ing that a therapy model is only as good as the science behind it, and are committed to the growing production of rigorous research examining CFT’s effectiveness.

THE SCIENCE UNDERLYING THE CFT MODEL A second question to ask in considering the science behind CFT is Where does CFT come from? In developing CFT, Paul Gilbert’s goal was not to create an entirely new model of psychotherapy in competition with other therapy models, but to integrate and build upon what existing science tells us about how humans get to be the way they are, and how we can best help them work with suffer- ing when things go wrong (personal communication, 2009). As such, CFT finds its roots in a large and varied body of scientific research, including the neuroscience of emotion and affiliation (e.g. Depue & Morrone-­Strupinsky, 2005; Cozolino, 2010), the existence and dynamics of basic evolved emotion-­regulation systems (e.g. Panksepp, 1998; Panksepp & Riven, 2012), and the social shaping of the self through attachment relationships (e.g. Schore, 1999; Siegel, 2012). In its approach to understanding the dynamics of emotion, CFT also draws heavily on behav- iorism (e.g. Ramnerö & Törneke, 2008) and upon cognitive science regarding things like the working of our implicit and explicit memory and emotion systems (e.g. Teasdale & Barnard, 1993). Likewise, in structuring our approach to treatment, CFT draws upon science documenting the social regulation of emotion (e.g. Cozolino, 2010; Porges, 2011) and growing evidence supporting the use of compassion practices (Hofmann, Grossman, & Hinton, 2011) and related therapeutic strategies in the treatment of psychological disturbances—­strategies such as mindfulness, mental- ization, and other interventions we’ll explore in this book. We won’t dive too much more deeply into the scientific basis of the therapy here, as the focus of this book is on the application of CFT, and there are existing resources that provide a detailed articulation of both the theoretical basis of CFT and the science that underlies it (see Gilbert, 2009a; 2010; 2014).

The Practice of CFT My goal in writing this book is to give you an accessible guide to learning and applying CFT. CFT Made Simple is primarily designed to be an entry point for mental health professionals who want to learn the CFT model and begin applying it in their clinical practice. It may also be useful for clients, or anyone who is interested in CFT and wants to learn more about it and how it is used in therapy.

LAYERED PROCESSES AND PRACTICES My hope is that after reading this book, you will understand CFT not as a collection of tech- niques, but as a set of layered processes and practices that interact and strengthen one another. These layered processes and practices are aimed at helping clients to establish and elaborate upon two common themes: developing compassion for themselves and others, and cultivating a repertoire of compassionate capacities for working courageously with suffering. This book will be loosely orga- nized to mirror this layered approach to CFT. Many of our clients will enter therapy with deeply seated shame and self-­criticism, or with lives that are defined by experiences of threat and emotional distance, volatility, and ambivalence. In the beginning, such clients may not be ready to benefit from diving into traditional self-­compassion practices. As with the practice of master gar- deners, the first few layers of CFT are designed to prepare the soil, so that when planted, the seeds of compassion will flourish. Let’s explore this layering: Therapeutic Relationship Compassionate Understanding Mindful Awareness Compassionate Practices Figure 1: Layered Processes and Practices in CFT

After a brief orientation to the origins and basic concepts of CFT in chapter 1, chapter 2 will provide an introduction to compassion and how it is operationalized in CFT, giving us a context for what is to come. In chapter 3 we’ll focus on the first layer in our approach: the therapeutic relation- ship. In the context of an unconditionally warm therapeutic relationship designed to help clients learn to feel safe, we’ll orient ourselves to the process of the therapy. We’ll explore the presence and roles served by the CFT therapist, and the general therapeutic approach used in CFT—­one of guided discovery. This relationship forms the first layer of compassion in CFT, as clients gradually learn to feel safe in relationship to the therapist, and to experience compassion coming to them, from this person who is committed to their well-­being. In chapters 4 through 6, we’ll begin exploring the second layer of compassion in CFT: compas- sionate understanding. We’ll learn how CFT helps clients to begin to understand their emotions and life experiences in nonblaming, compassionate ways. This work is done via the development of understanding about how their minds and lives have been shaped by forces that they neither chose nor designed—­evolution, social shaping, and the ways these interact. We’ll revisit this theme later in the book, introducing a CFT-­based model of case formulation in chapter 13. In chapter 7, we’ll turn our focus to compassionate, mindful awareness, which is the third layer of compassion in CFT. We’ll explore strategies to rapidly help clients increase their awareness of their emotions, thoughts, and motives. We’ll also consider ways to help our clients not get caught up in some of the common obstacles that often hamper beginners in their efforts to learn mindfulness. In chapters 8 through 15 we’ll formally turn our focus to the fourth layer: compassionate prac- tices for working with suffering. In chapter 8, we’ll explore how to help clients develop motivation to shift from a self-­critical to a compassionate perspective in working with their challenges. In chapter 9, we’ll explore how to help clients develop the compassionate self—­a wise, kind, courageous, adaptive version of themselves that will serve as a reference point from which they can develop the courage to work with the things that terrify them, and the compassionate strengths to use in doing so. We’ll then explore ways to help clients cultivate compassionate thinking and reasoning (chapter 10) and the ability to use compassionate imagery to self-­soothe and deepen compassion for them- selves and others (chapter 11), and introduce the use of chair work and perspective-­taking exercises in helping clients strengthen the compassionate self, giving it a central role in their lives (chapter 12). In chapter 14, we’ll explore the Multiple Selves exercise—­a powerful method for bringing compassion to difficult emotions and situations—­and in chapter 15, we’ll explore how the compas- sionate perspective offered by a CFT approach can fit with and enhance the tools you already use in your therapy practice. Together, these layers provide a framework for learning CFT, and for how CFT can be used in conjunction with empirically supported technologies of change such as behavior activation or exposure. Hopefully you’re beginning to realize that CFT is not simply a recycled form of cogni- tive behavioral therapy with some compassion practices pulled from Buddhism added in for good measure. We’re working to layer an interactive set of processes—­nurturing relationships, powerful understandings, deepening awareness, and the purposeful cultivation of compassionate strengths— to help clients shift away from threat-­focused ways of existing in the world and toward a perspec- tive that is kind, wise, and confident, and which draws upon a body of effective skills for working directly and courageously with life challenges.

WHAT IF MY CLIENT DOESN’T BELIEVE IN EVOLUTION? One factor distinguishing CFT from other therapy models is that we consider human emotions, motives, and behavior in an evolutionary context. This understanding helps facilitate compassion for ourselves and other people, because much about how these experiences play out in us makes a lot of sense given our evolutionary history. Given the current cultural environment in the West, I thought it might be useful to consider what to do if we find ourselves working with someone who doesn’t agree with the theory of evolution. News articles indicate that approximately one-­third of Americans don’t believe in evolution theory, instead ascribing human origins to the action of a supreme being. In fact, evidence suggests that rates of belief in evolution may be declining in some groups (Kaleem, 2013). So it’s likely that at some point we’ll encounter clients who simply don’t subscribe to the theory of evolution. I certainly have. Is this a problem for CFT? Well, yes and no. Certainly CFT therapists do not have an agenda around challenging clients’ spiritual beliefs or religion, and there are plenty of CFT therapists who have religious beliefs of their own. Trying to change the mind of someone who is motivated to reject the idea of evolution is probably not going to be helpful, and may actively undermine the therapeutic relationship. There are a few ways we could work with this issue. We could refer such clients to clinicians who utilize approaches that don’t emphasize evolution—­which is pretty easy to do, as there are many therapies that don’t speak to it at all. Alternatively, we could continue with CFT, leaving out the evolution pieces. I don’t see either of these solutions as optimal. There are lots of people who may not believe in evolution, but who could still benefit from CFT. At the same time, evolution isn’t a small facet of the therapy—­it plays a significant role in how we conceptualize the brain, the mind, and the problems our clients bring us. I’d suggest some middle ground, which can actually help us create a model for how to work with difficult issues that will come up in therapy: Honestly discuss the issue in a way that names the situation, and enlist the client in considering how to work with it. We can also soften or omit lan- guage around evolution across species, instead emphasizing adaptation within the human species—­ referring to how our challenging characteristics may have been quite useful for our human ancestors (who faced very different threats and demands than we do now), even as these qualities play out in ways that aren’t very well suited to modern life. Here’s an example of how that conversation might take shape:

Therapist: Evan, as we continue to explore our emotions and how they work, I wanted to mention that I’ll be talking about evolution—­specifically about how our emotions make sense when we look at them in an evolutionary context. I know that some people don’t accept the theory of evolution, and I wanted to touch base about that. Evan: (stiffening a bit) I don’t believe in evolution. I believe that God created humans, just as we are. Therapist: Good—­that’s what I wanted to clarify. I want to say at the outset that I don’t have any agenda around challenging or changing anyone’s religious beliefs. People have different beliefs, and there are different ways of understanding how we got here, and how we got to be the way we are. So I’m not going to try and push any beliefs on you. Evan: (visibly relaxing) Good. Because that wouldn’t have gone very well. Therapist: (smiling warmly) I don’t imagine it would have! So I want you to know that I respect your beliefs, but at the same time, the therapy we’ll be doing is based on science, and so I’ll sometimes be talking about things from a scientific perspective—­because it can help us make sense of how our emotions work. You don’t need to accept the theory of evolution for us to proceed. All I need you to accept is that we have brains and minds that sometimes work in tricky ways to produce emotions that can be hard for us to handle. How does that sound? Evan: That’s not hard to accept. I’ve definitely got some emotions that are hard to handle. Therapist: Most of us do. Now, I’ll probably still talk about evolution from time to time, because I come from a scientific perspective, and that’s the way I make sense of things. How about when I do that, I’ll talk about it as “from the scientific perspective,” which you can choose to agree with or disregard—­taking what is helpful and ignoring the rest. What do you think? Evan: Sounds like it’s worth a try. Therapist: We can also focus on things as they played out for humans across the years, as our societies have changed. The idea is that our brains work in ways that may have helped our ancestors—­say, humans who lived in isolated villages in a harsh world that included lots of very real physical threats—­but which can be less useful in the modern world, in which most of the threats we face are very different. What do you think? Evan: I don’t have any problem with that. I know humans have lived in different ways over time. It’s the “coming from monkeys” stuff that I don’t believe. Therapist: It sounds like we’ve got lots of room to work with, then. Also, if it does seem like this issue is getting in the way of our therapy, I’d appreciate it if you’d let me know. If that were to happen, we could explore it together and figure out a way to work with it. What I don’t want to happen is for you to be uncomfortable or unhappy with the therapy and for me to be clueless about it. Evan: Sounds good. I’ve found that once clients understand that I respect their right to hold different beliefs and am not trying to change them, the evolutionary perspective becomes much less of an issue. I’ve also found that using the phrase “from a scientific perspective…” allows me to continue talking about things in the manner we’ll explore in this book, and that clients can often accept it—­because we’re acknowledging that there are other, valid perspectives as well. I’ve even had clients come up with alternative explanations, such as “This tricky brain is a riddle that God gave me to figure out.” Sometimes, I’ve found that as clients see how the information I’m presenting fits with their lived experience and helps explain how their emotions work, they tend to soften to the evolutionary perspective (without giving up any of their religious beliefs). Even clients who generally reject the concept of evolution are often willing to consider adapta- tions occurring within the human race that fit better with some times in our history than others, and that’s a good thing. The evolutionary piece isn’t just about deshaming emotions by considering why we have them. It also helps us clarify and understand the ways that different emotions play out in us. When we consider that threat emotions like anger and anxiety evolved to help us identify threats and rapidly do what is needed to deal with them, it makes complete sense that when we perceive a threat, our attention, thoughts, and imagery would all be drawn to the threat until the situation is resolved—­in the harsh world faced by our ancestors, ignoring sources of threat could mean injury or death. The problem is that these threat responses are better suited to the savannahs and forests faced by our ancestors than to the boardrooms and relationships that form most of our modern-day threats—­and they are of no use at all in facing the multitude of threats dreamt up entirely via our “new-brain” capacities for thought, imagery, and fantasy.

CFT AND OTHER THERAPIES One of the things I like best about CFT is that it is generally quite compatible with other therapy models. We’ll explore this compatibility in the final chapter of the book, and will highlight it along the way. Regardless of whether you want to become a “CFT therapist” or simply want to use a compassion focus to enhance and deepen your work within your current therapeutic modality, I hope you’ll find much here to draw upon. CFT isn’t intended to be an entirely new model of therapy, but rather a basis for compassion- ately understanding and working with psychological difficulties. Relative to other therapies, you may find that CFT is distinguished by its emphasis on compassion as well as on conceptualizing human problems in terms of evolution; how emotions and basic motives play out in our brains, or minds; and the ways we can learn to help ourselves feel safe as we confront and work with the things that scare us the most. At the technical level, you’ll likely find a number of new therapeutic tools here, but there will be things you’ll recognize from other therapies as well. I think it’s fair to say that CFT fits well into the “third wave” of behavioral and cognitive behav- ioral therapies, alongside acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), functional analytic psychotherapy (FAP), mindfulness-­based cognitive therapy (MBCT), and emotion-­focused therapy (EFT). As with these therapies, we rely on behavioral principles and don’t seek to change the content of problematic cognitions and emotions so much as to change our relationship to these mental experiences (while cultivating more helpful ways of attending and think- ing). As with many of these other approaches, mindfulness plays an important role in CFT. I think the experiential emphasis and perspective-­taking practices used in CFT will resonate with practi- tioners of ACT, and as with DBT, we place a significant emphasis on things like distress tolerance and learning to work with acutely difficult emotional experiences. Longstanding cognitive therapists may find new ways to approach thought work that can help to facilitate affective congruence in their clients—­so that new, reassuring thoughts feel reassuring to them. You may also find that the ways compassion is brought into CFT therapy have the poten- tial to “warm up” longstanding approaches such as exposure therapy, to make them more accessible for clients and more comfortable for therapists. I think practitioners will also discover aspects of CFT that can enhance and deepen their existing therapy practice—­things like considering emo- tions and motives in an evolutionary context, helping clients work with evolved affective systems to create feelings of safeness, and applying the purposeful cultivation of compassion in facilitating one’s willingness and ability to work directly with suffering.

Our Current Approach Particularly in psychotherapy, I think it’s nice when a learning process models, shapes, and reinforces the content that is being learned. That’s what we’re going to strive for here. The process of CFT—­regardless of what we happen to be working on with our clients at the time—­is one of warmth, guided discovery, courage, and commitment. You’ll find that this book features a fair number of experiential exercises. Occasionally, I’ll ask you to do some of the same things that CFT therapists ask their clients to do, and I’d like to for- mally encourage you to practice all of the exercises yourself before trying them out with clients. We can learn about things like compassion, mindfulness, and safeness, but if we really want to under- stand them, we need to experience them. Personal practice can give us a depth of understanding with regard to these practices—­the nuances, potential obstacles, and how to overcome them—­that can be very difficult to get any other way. With that in mind, I’d like to begin this book with a motivation-­setting exercise drawn from my experiences learning from Buddhist teachers. These teachers believed that our motivation or inten- tion, the reason we are engaging in a particular activity, is highly related to the outcome of the activ- ity. As I’ve already mentioned, motivation is also a core component of compassion, and it’s a component that we’ll be working to help our clients cultivate. So let’s do that now.

WORKING WITH MOTIVATION AND INTENTION As we go through life, we’ll do lots of different things, for lots of different reasons. Sometimes our activities will be driven by feelings of obligation, sometimes by excitement or ambition. We go through the day figuratively (and sometimes literally) checking off items on our list, doing things simply so that we can move on to the next thing that needs to be done. But motivation and intention are aspects of life we can work with. So right now, I’d like you to consider your motivation for doing this activity. Why are you reading this book? Perhaps you’ve heard about CFT and were curious to learn more? Perhaps you’ve been looking for ways to deepen or enliven your existing therapy practice? Perhaps you’re a psychotherapy client whose therapist uses CFT, and you wanted to learn more about it? Maybe something about the cover caught your eye, and you impulsively bought the book to see what it was about, as I often do. Compassionate motivation is something we can choose to cultivate. Now that we’ve found ourselves here together, let’s see if we can bring up a kind, committed sort of motivation as we go about exploring compassion-­focused therapy. •Consider the therapy situation. Our clients come to us at their most vulnerable, sharing their struggles and suffering, and asking, “Will you help me?” Could anyone ever pay us any greater honor than this? Open yourself to the feeling of wanting to help them work with this suffering. •Is it possible that we can do this—­me thinking, organizing, and writing; you reading, considering, and practicing—­out of a deep commitment to help alleviate suffering in our clients, ourselves, and the world? •What if we really felt that commitment to alleviate suffering—­felt a deep wish to help those who are struggling? •Don’t worry about whether you do or don’t feel it right now. Instead, simply try to imagine what it would be like if you really did feel it—­this deep desire to further your ability to help those who suffer most. •What if that were our motivation? How might it shape the way we engage in learning about and practicing CFT? Let’s see if we can carry that compassionate motivation with us as we proceed.