引言

引言

一位女士说：“请告诉我们关于痛苦。” 他说：你们的痛苦，是包裹着你们理解的壳子破裂的结果。 正如果实的核必须破裂，其核心才能沐浴在阳光下，你们也必须经历痛苦。 如果你们能对日常生活中奇迹般的生命保持惊奇之心，那么你们的痛苦也不会显得比快乐更不神奇； 你们会接受心灵的季节，就像你们一直接受田野上的季节一样。 你们会以宁静的心态度过哀伤的冬季。 ——卡里·纪伯伦，《先知》

同情慈悲的意义

同情慈悲涉及允许自己被痛苦触动，并体验到帮助减轻和预防痛苦的动机。同情慈悲源于这样的认识：从根本上说，我们都只是想快乐，不想受苦。在这本书中，你们将了解到同情慈悲聚焦疗法（CFT），这是一种专注于有意培养同情慈悲心、从中产生的技能和力量，以及如何使用这些技能有效应对人类痛苦的疗法。当我们看到我们共同面临的处境——仅仅因为我们拥有人类的生活——就会有一种深刻的认识：面对所有潜在的痛苦和挣扎，同情慈悲是唯一合理的回应。

为什么我们需要同情慈悲？

我们需要同情慈悲，因为生活是艰难的。即使我们出生在一个相对优越的环境中，有充足的食物、舒适的住所、爱我们的人、教育和追求目标的机会——即使我们拥有一切，我们仍将在生活中面临巨大的痛苦。我们都会生病、变老、死去。我们都会失去所爱的人。我们都会在追求迫切渴望的目标时竭尽全力，却失败。大多数人都会经历心碎，不止一次，而是多次。拥有一个人类的生活就意味着我们将面临痛苦。这是入场的代价。生活对每个人都是艰难的。

但我们可能会忘记这一点。我们可能会忘记所有人都会受伤，这些感受是普遍的——是我们作为人类彼此联系的一部分。我们中的许多人，以及我们寻求帮助的人，可能会把这些挣扎和情绪视为孤立的，认为这是自己有问题的标志。我们可能会远离他人，而不是向他们求助。我们可能会以批评、攻击和羞愧的态度面对自己的挣扎，而不是给予自己支持、鼓励和安慰。即使我们知道更好的做法，也很难让自己感到安心。做一个人类确实是一件复杂的事情。对于一些人来说，比如我们寻求帮助的心理治疗来访，事情会更加困难。

同情慈悲聚焦疗法（CFT）

正是这些观察启发了我的亲爱的朋友和同事保罗·吉尔伯特开发了同情慈悲聚焦疗法。CFT旨在帮助治疗师以非指责的方式理解来访的心理痛苦，并为他们提供有效的方法来应对这种痛苦。近年来，CFT越来越多地被心理健康提供者使用——最初是在英国开发，后来在世界其他地区也越来越普及。它也成为越来越多实证研究的焦点。

CFT是什么？它有什么用？

CFT将各种基于科学的方法与已有数千年历史的心灵训练实践相结合，以进化心理学、情感神经科学（特别是归属感的神经科学）、依恋理论、行为主义和认知行为疗法（CBT）以及支持正念和同情慈悲实践的有效性的文献为基础。CFT专注于帮助来访以同情慈悲的方式应对困难，并提供有效的应对挑战情绪和情境的方法。

CFT最初是为了帮助那些倾向于羞耻和自我批评的患者而开发的，即使他们在参与基于证据的治疗方案（如CBT）时仍然难以应对治疗（Gilbert, 2009a; Rector et al., 2000）。例如，这样的患者可能能够产生诸如“我知道发生的事情不是我的错”这样的想法，但在情感上却难以感到安心。CFT的重点是创建来访思维（例如，有益的想法）和情感（例如，安心）之间的一致性。CFT帮助患者以温暖、接纳和鼓励的方式应对自己的挣扎和他人的困境，帮助他们感到安全和自信地应对挑战性的情绪和生活困难。

CFT已应用于越来越多的问题，包括抑郁症（Gilbert, 2009a; Gilbert, 2009b）、精神病（Braehler et al., 2013）、暴食症（Kelly & Carter, 2014; Goss, 2011）、焦虑症（Tirch, 2012）、愤怒（Kolts, 2012）、创伤（Lee & James, 2011）、社交焦虑（Henderson, 2010）和人格障碍（Lucre & Corten, 2013）。

CFT的方法

越来越多的实证研究表明，同情慈悲干预在心理治疗中的潜在用途（Hofmann, Grossman, & Hinton, 2011）。CFT与其他包含同情慈悲的疗法的一个区别在于，我们专注于帮助来访在进化的背景下理解他们的挑战（我们的大脑如何进化以产生基本的动机和情绪）、情绪在大脑中的动态以及塑造自我的社会因素，尤其是在生命的早期。这些因素都不是来访选择或设计的，但它们在来访的挣扎中起着巨大作用。在本书中，你将学习如何帮助来访将这些理解应用于他们的问题，使他们停止因无法控制的事情而自责和攻击自己，而是专注于建设更好的生活。虽然羞耻感与回避行为有关，这可能加剧来访的挣扎（Carvalho, Dinis, Pinto-Gouveia, & Estanqueiro, 2013），但同情慈悲可以为来访提供一种以接受和温暖的态度应对困难的方法，使他们能够面对并处理这些问题。

在CFT中，来访学习不同情慈悲绪和基本动机如何进化以服务于特定功能，探讨这些情绪如何在现代环境和新大脑的意象、意义建构和象征思维能力的结合下产生有趣的挑战。例如，来访学习如何从进化的角度理解焦虑和愤怒等威胁情绪的复杂动态，这揭示了为什么人们很容易在这种情绪中“卡住”，这有助于减少来访因自己的感受而自责的倾向。CFT还探讨了社会环境和依恋关系如何将我们潜在的遗传特征转化为具有挑战性的行为和情绪。这种探索为自我同情慈悲的生根创造了条件，因为患者开始意识到，许多导致和维持他们问题的因素并不是他们的选择或设计，因此不是他们的错。

在CFT中，去羞耻化的过程伴随着通过培养同情慈悲心来同时建立责任和情感勇气。患者学习如何利用进化的情绪调节系统，使自己在接近和主动应对生活挑战时感到安全和自信。他们被指导开发适应性的、同情慈悲的策略，以应对情绪、关系和困难的生活情境。在CFT中，重点是帮助来访学会停止为他们无法选择或设计的事情自责，并熟练地应对他们可以影响的因素，以建立一套应对生活挑战和建设充实有意义生活的技能。正如我们将探讨的，这既通过治疗的隐性方面实现，如治疗关系和引导发现的治疗重点，也通过具体的技巧实现，如意象、同情慈悲培养练习和同情慈悲推理的发展。

CFT的证据基础

在过去一个世纪左右，心理健康领域最重要的运动之一是强调我们的治疗应基于坚实的科学。支持CFT的证据基础有两个方面：首先，有越来越多的研究支持CFT干预的有效性；其次，有几项基础文献提供了CFT理论及其治疗过程层面成分的科学依据。尽管本书的重点是学习治疗，但我希望简要介绍一下CFT背后的科学。

CFT干预的证据

当然，首先要考虑的问题是：CFT有效吗？目前支持CFT干预有效性的研究虽然规模较小，但正在迅速增长。研究表明，CFT可以帮助减少自我批评、羞耻、压力、抑郁和焦虑（Gilbert & Proctor, 2006; Judge, Cleghorn, McEwan, & Gilbert, 2012）。其他研究记录了使用CFT对患有精神障碍（Braehler et al., 2013; Laithwaite et al., 2009）、饮食障碍（Kelly & Carter, 2014; Gale, Gilbert, Read, & Goss, 2014）、人格障碍（Lucre & Corten, 2013）、问题性愤怒（Kolts, 2013）和脑外伤（Ashworth, Gracey, & Gilbert, 2011）的人的积极结果，以及在眼动脱敏和再处理治疗创伤时的结合使用（Beaumont & Hollins Martin, 2013）。

支持CFT有效性的现有文献的主要限制是缺乏随机对照试验（RCTs）来证明其效果。截至本书写作时，有两篇RCT文章发表。其中一篇（Kelly & Carter, 2014）显示，CFT在减少暴食、整体饮食障碍病理和饮食及体重担忧方面有显著影响，并增加了自我同情慈悲。第二篇（Braehler et al., 2013）记录了CFT在改善精神障碍患者临床症状方面相对于对照组的效果，以及伴随的同情慈悲增加与抑郁和感知社会边缘化的减少相关。最近的一项系统综述（Leaviss & Uttley, 2014）得出结论，CFT在治疗心理障碍方面显示出前景，尤其是对高度自我批评的个体，但指出在做出CFT是一种基于证据的治疗方法的明确声明之前，还需要更多高质量的临床试验。我们CFT社区同意这一评估，认为一种治疗模型的好坏取决于其背后的科学，并致力于生产更多严谨的研究来检验CFT的有效性。

CFT模型的科学基础

在考虑CFT背后的科学时，第二个需要提出的问题是：CFT的来源是什么？在开发CFT时，保罗·吉尔伯特的目标并不是创造一个全新的心理治疗模型，与现有的其他治疗模型竞争，而是整合和建立在现有科学对人类如何成为现在的样子以及如何在出现问题时最好地帮助他们应对痛苦的理解之上（个人交流，2009）。因此，CFT植根于大量且多样的科学研究中，包括情感和归属感的神经科学（例如Depue & Morrone-Strupinsky, 2005; Cozolino, 2010）、基本进化情绪调节系统的存在和动态（例如Panksepp, 1998; Panksepp & Riven, 2012），以及通过依恋关系的社会塑造自我（例如Schore, 1999; Siegel, 2012）。

在理解情绪动态的方法上，CFT还大量借鉴了行为主义（例如Ramnerö & Törneke, 2008）和认知科学关于隐性和显性记忆和情绪系统的工作原理（例如Teasdale & Barnard, 1993）。同样，在构建我们的治疗方法时，CFT借鉴了记录社会情绪调节的科学（例如Cozolino, 2010; Porges, 2011）和越来越多的支持使用同情慈悲实践（Hofmann, Grossman, & Hinton, 2011）及相关治疗策略（如正念、心智化和其他我们在本书中将探讨的干预措施）来治疗心理障碍的证据。我们在这里不会深入探讨治疗的科学基础，因为本书的重点是CFT的应用，而且已经有一些资源详细阐述了CFT的理论基础和其背后的科学（参见Gilbert, 2009a; 2010; 2014）。

CFT的实践

我写这本书的目的是为你提供一个易于理解的指南，以学习和应用CFT。《简化CFT》主要设计为心理健康专业人士的入门点，他们希望学习CFT模型并开始将其应用于临床实践中。它也可能对来访或任何对CFT感兴趣并希望了解更多关于CFT及其在治疗中的应用的人有用。

分层的过程和实践

我希望读完这本书后，你能将CFT理解为一系列相互作用和加强的分层过程和实践，而不仅仅是一系列技术。这些分层的过程和实践旨在帮助来访建立和发展两个共同主题：对自己和他人的同情慈悲，以及培养一系列应对痛苦的同情慈悲能力。本书将松散地组织成反映CFT分层方法的结构。许多来访进入治疗时，内心深处充满了羞耻和自我批评，或者他们的生活被威胁、情感疏远、波动和矛盾所定义。在初期，这样的来访可能还没有准备好从传统的自我同情慈悲实践中受益。就像园艺大师的实践一样，CFT的前几层旨在准备土壤，以便当种子播下时，同情慈悲之花能够茁壮成长。让我们来探讨这些层次：

图1：CFT中的分层过程和实践

1. 治疗关系
2. 同情慈悲的理解
3. 正念觉知
4. 同情慈悲的实践

在第1章简要介绍CFT的起源和基本概念后，第2章将介绍同情慈悲及其在CFT中的操作化，为我们接下来的内容提供背景。第3章将重点介绍我们的方法的第一层：治疗关系。在一种无条件温暖的治疗关系中，帮助来访学会感到安全，我们将介绍治疗过程。我们将探讨CFT治疗师的存在和角色，以及CFT中使用的总体治疗方法——引导式发现。这种关系构成了CFT中的第一层同情慈悲，来访逐渐学会在与治疗师的关系中感到安全，并体验到来自这位致力于他们福祉的人的同情慈悲。

第4章至第6章，我们将开始探讨CFT中的第二层同情慈悲：同情慈悲的理解。我们将学习CFT如何帮助来访以非指责、同情慈悲的方式理解他们的情绪和生活经历。这项工作是通过发展对他们的思想和生活如何被他们没有选择或设计的力量（如进化、社会塑造及其互动）所塑造的理解来进行的。我们将在本书后面再次探讨这个主题，并在第13章介绍基于CFT的案例构建模型。

第7章，我们将关注CFT中的第三层同情慈悲：同情慈悲的正念觉知。我们将探讨快速帮助来访提高对情绪、思想和动机的觉知的策略。我们还将考虑如何帮助来访避免一些常见的障碍，这些障碍往往阻碍初学者学习正念的努力。

第8章至第15章，我们将正式转向第四层：应对痛苦的同情慈悲实践。第8章，我们将探讨如何帮助来访培养从自我批评转变为同情慈悲视角的动力，以应对他们的挑战。第9章，我们将探讨如何帮助来访培养同情慈悲自我——一个智慧、善良、勇敢、适应性强的自我版本，这将成为他们应对恐惧事物和培养同情慈悲力量的参考点。接下来，我们将探讨如何帮助来访培养同情慈悲思考和推理（第10章），以及如何使用同情慈悲意象来自我安抚并加深对自己和他人的同情慈悲（第11章），并介绍使用椅子工作和换位练习来帮助来访强化同情慈悲自我，使其在他们的生活中占据中心地位（第12章）。第14章，我们将探讨多重自我练习——一种强大的方法，用于应对困难情绪和情境。第15章，我们将探讨CFT提供的同情慈悲视角如何与你已经使用的治疗工具相结合并增强这些工具。

这些层次共同提供了一个学习CFT的框架，以及如何将CFT与行为激活或暴露等经过实证支持的改变技术结合使用。希望你已经开始意识到，CFT不仅仅是简单地将一些从佛教中提取的同情慈悲实践添加到认知行为疗法中。我们正在分层构建一个互动的过程集——滋养关系、深刻的理解、深化的觉知和有目的的同情慈悲力量的培养——以帮助来访从以威胁为中心的生存方式转向一种善良、智慧、自信的视角，这种视角依赖于一系列有效的技能，直接而勇敢地应对生活挑战。

如果来访不相信进化论怎么办？

区分CFT与其他治疗模型的一个因素是我们从进化的角度考虑人类的情绪、动机和行为。这种理解有助于促进对自己和他人的同情慈悲，因为从我们的进化历史来看，这些体验在我们身上的表现是有道理的。鉴于西方当前的文化环境，我认为有必要考虑如果遇到不相信进化论的来访该怎么办。新闻报道表明，大约三分之一的美国人不相信进化论，而是认为人类的起源是由一位至高无上的存在创造的。事实上，有证据表明某些群体对进化论的信仰率可能正在下降（Kaleem, 2013）。因此，我们很可能会遇到根本不相信进化论的来访。我自己就遇到过这种情况。

这对CFT来说是个问题吗？答案是：既是也不是。当然，CFT治疗师没有挑战来访宗教信仰或宗教的议程，而且有很多CFT治疗师自己也有宗教信仰。试图改变那些有动力拒绝进化论想法的人的观点可能是没有帮助的，甚至可能破坏治疗关系。我们可以采取几种方法来处理这个问题。我们可以将这些来访转介给不强调进化的临床医生——这相对容易，因为有很多疗法根本不涉及进化。或者，我们可以继续进行CFT，但省略掉进化部分。我不认为这两种解决方案是最佳的。有很多人可能不相信进化论，但他们仍然可以从CFT中受益。同时，进化并不是治疗中的一个小方面——它在我们如何理解大脑、心灵和来访带来的问题方面起着重要作用。

我建议采取中间立场，这实际上可以帮助我们创建一个处理治疗中可能出现的困难问题的模型：诚实地讨论问题，明确情况，并邀请来访一起考虑如何处理。我们还可以软化或省略跨物种进化的语言，而是强调人类内部的适应性——提到我们的某些挑战性特质对我们的祖先（他们面临的威胁和需求与我们现在大不相同）可能非常有用，即使这些特质在现代社会的表现方式并不适合。下面是一个这样的对话示例：

治疗师：伊万，随着我们继续探讨情绪及其运作机制，我想提一下我会谈到进化——特别是当我们从进化的角度来理解情绪时，很多东西会更有意义。我知道有些人不接受进化论，所以我想在这方面先沟通一下。

伊万：（有些僵硬）我不相信进化论。我相信上帝创造了人类，就像我们现在这样。

治疗师：好的，这就是我想澄清的。我想一开始就说明，我没有挑战或改变任何人宗教信仰的议程。每个人有不同的信仰，也有不同的方式来理解我们是如何来到这里的，以及我们是如何成为现在的样子的。所以我不会试图强加任何信仰给你。

伊万：（明显放松）那就好。否则事情不会顺利。

治疗师：（温暖地微笑）我也想象不到会顺利！所以我想让你知道，我尊重你的信仰，但同时，我们将进行的治疗是基于科学的，所以我有时会从科学的角度谈论一些事情——因为这有助于我们理解情绪是如何工作的。你不需要接受进化论，我们才能继续。我只需要你接受我们的大脑和心灵有时会以复杂的方式产生情绪，这些情绪对我们来说很难处理。你觉得怎么样？

伊万：这不难接受。我确实有一些难以处理的情绪。

治疗师：大多数人都有。不过，我可能还是会时不时地谈到进化，因为我来自科学的角度，这是我理解事物的方式。当你听到我从科学的角度谈论这些时，你可以选择同意或忽略——取其有用的部分，忽略其余的。你觉得怎么样？

伊万：听起来值得一试。

治疗师：我们也可以关注人类历史上随社会发展而发生的变化。核心思想是，我们的大脑以某种方式工作，这些方式可能曾帮助我们的祖先——比如生活在严酷环境中孤立村庄的人类，那里有很多真实的物理威胁——但在现代社会中，我们面临的大多数威胁是非常不同的，这些方式可能就不那么有用。你觉得怎么样？

伊万：我没有问题。我知道人类的历史上生活方式各不相同。我只是不相信“从猴子进化而来”的说法。

治疗师：听上去我们有很多合作的空间。另外，如果这个问题似乎妨碍了我们的治疗，我希望你能告诉我。如果发生这种情况，我们可以一起探讨并找到解决办法。我不想让你对治疗感到不适或不满意，而我却一无所知。

伊万：听起来不错。

我发现一旦来访理解我尊重他们持有不同信仰的权利，并且不试图改变他们，进化论的视角就变得不再那么重要了。我还发现，使用“从科学的角度……”这样的短语让我可以继续以本书中探讨的方式谈论问题，而来访通常也能接受这一点——因为我们承认还有其他有效的视角。有时，来访会提出替代解释，比如“这个复杂的头脑是上帝给我解谜的”。

有时，我发现当来访看到我提供的信息如何符合他们的实际体验，并帮助解释他们的情绪如何工作时，他们会更加接受进化论的视角（而不放弃他们的宗教信仰）。

即使是普遍拒绝进化论概念的来访，也往往愿意考虑人类历史中某些时期内发生的适应性变化，这是件好事。进化论不仅仅是为了通过考虑我们为什么会有这些情绪来消除对情绪的羞耻感，它还帮助我们澄清和理解不同情慈悲绪在我们身上的表现方式。当我们考虑到像愤怒和焦虑这样的威胁情绪进化是为了帮助我们识别威胁并迅速采取行动应对时，完全有道理的是，当我们感知到威胁时，我们的注意力、思想和意象都会集中在威胁上，直到情况得到解决——在祖先面临的严酷世界中，忽视威胁源可能导致受伤或死亡。问题是，这些威胁反应更适合祖先面临的草原和森林，而不是构成我们现代威胁的会议室和人际关系——更不用说完全由我们“新大脑”的思考、意象和幻想能力构想出的多种威胁了。

CFT与其它疗法

我对CFT最喜欢的一点是它通常与其他治疗模型相当兼容。我们将在本书的最后一章探讨这种兼容性，并在书中不断强调。无论你是想成为一名“CFT治疗师”，还是仅仅希望利用同情慈悲焦点来增强和深化你在当前治疗模式中的工作，我都希望你能从中找到许多可以借鉴的内容。

CFT并不是旨在成为一个全新的治疗模型，而是一个以同情慈悲为基础来理解和处理心理问题的基础。与其他疗法相比，你可能会发现CFT的特点在于其对同情慈悲的强调，以及从进化的角度来概念化人类问题；情绪和基本动机在我们的大脑或心灵中的表现；以及我们如何学会在面对和处理最令我们害怕的事情时让自己感到安全。在技术层面，你可能会发现许多新的治疗工具，但也有一些你会从其他疗法中认出的东西。

可以说，CFT很好地融入了行为和认知行为疗法的“第三波”，与接受和承诺疗法（ACT）、辩证行为疗法（DBT）、功能分析心理治疗（FAP）、基于正念的认知疗法（MBCT）和情感聚焦疗法（EFT）并驾齐驱。与这些疗法一样，我们依赖行为原则，不是试图改变有问题的认知和情绪的内容，而是改变我们与这些心理体验的关系（同时培养更有帮助的注意和思维方式）。正如这些其他方法一样，正念在CFT中扮演着重要角色。我认为CFT中使用的体验重点和视角转换练习会让ACT从业者产生共鸣，而像DBT一样，我们非常重视痛苦耐受和学习如何处理极度困难的情感体验。

长期从事认知治疗的治疗师可能会发现新的方法来处理思维工作，以帮助来访实现情感一致性——使新的、令人安心的想法真正让他们感到安心。你可能会发现，将同情慈悲引入CFT治疗的方式有可能“温暖”一些传统的做法，如暴露疗法，使其对来访更易接受，对治疗师更舒适。我认为从业者还会发现CFT的某些方面可以增强和深化他们现有的治疗实践——例如，从进化的角度考虑情绪和动机，帮助来访处理进化的情感系统以创造安全感，以及有目的地培养同情慈悲心，以促进直接应对痛苦的意愿和能力。

我们当前的方法

特别是在心理治疗中，我认为当学习过程能够建模、塑造和强化所学内容时，这是一个很好的体验。这就是我们在这里努力实现的目标。无论我们当前与来访进行何种工作，CFT的过程都是温暖、引导性发现、勇气和承诺的过程。

你会发现这本书包含了许多体验练习。偶尔，我会要求你做一些CFT治疗师要求来访做的事情，我正式鼓励你在尝试这些练习之前先自己实践。我们可以学习同情慈悲、正念和安全感，但如果真的想理解它们，我们需要亲身体验。个人实践可以让我们对这些练习有更深层次的理解——包括细微差别、潜在障碍以及如何克服它们——这些都是通过其他方式很难获得的。

鉴于此，我想以一个来自我向佛教老师学习的经验的动机设定练习作为本书的开头。这些老师认为，我们的动机或意图，即我们从事某项活动的原因，与活动的结果高度相关。正如我已经提到的，动机也是同情慈悲的核心组成部分，是我们将帮助来访培养的组成部分。现在让我们来做这个练习。

处理动机和意图

在生活中，我们会出于各种不同的原因做很多事情。有时我们的活动是由义务驱动的，有时则是由兴奋或雄心驱动的。我们整天象征性地（有时甚至是字面上地）勾选清单上的项目，只是为了继续去做下一件需要完成的事情。但动机和意图是我们可以处理的生活方面。

现在，请你考虑一下你做这个活动的动机。你为什么读这本书？也许你听说过CFT并对了解更多信息感到好奇？也许你一直在寻找方法来深化或激活你现有的治疗实践？也许你是心理治疗的来访，你的治疗师使用CFT，你想了解更多？或许书的封面吸引了你，你冲动地买了这本书来看看它是关于什么的，就像我经常做的那样。

同情慈悲的动机是我们可以选择培养的。既然我们已经聚在一起，让我们看看能否在探索以同情慈悲为中心的治疗过程中，培养一种善良、坚定的动机。

• 考虑治疗的情境。我们的来访在最脆弱的时候来找我们，分享他们的挣扎和痛苦，并问：“你能帮助我吗？”还有什么比这更大的荣誉呢？
• 我们是否可以这样做——我思考、组织和写作；你阅读、思考和实践——出于深切的承诺，帮助减轻来访、我们自己和世界的痛苦？
• 如果我们真的感受到这种减轻痛苦的承诺——深切的愿望帮助那些挣扎的人，会怎样？
• 不要担心你现在是否感受到了这一点。相反，试着想象如果你真的感受到了会是什么样子——这种深切的愿望，进一步提升你帮助那些最痛苦的人的能力。
• 如果这就是我们的动机，它将如何塑造我们学习和实践CFT的方式？

让我们在继续前行的过程中带着这种同情慈悲的动机。

进一步阐述的知识点

• 痛苦的本质

  • 痛苦是包裹着我们理解的壳子破裂的结果。就像果实的核必须破裂，其核心才能沐浴在阳光下，我们也必须经历痛苦才能成长和理解生命。
  • 痛苦是生活的一部分，每个人都不可避免地会经历病痛、衰老、死亡、失去所爱的人、追求目标的失败和心碎。这些痛苦是人类生活的入场券，没有人能完全避免。

• 同情慈悲的意义

  • 同情慈悲涉及允许自己被痛苦触动，并体验到帮助减轻和预防痛苦的动机。同情慈悲源于这样的认识：从根本上说，我们都只是想快乐，不想受苦。
  • 同情慈悲不仅是对他人，也是对自己。通过同情慈悲，我们可以更好地理解自己和他人的痛苦，从而找到应对的方法。

• 为什么我们需要同情慈悲？

  • 生活是艰难的，即使在优越的环境中，我们也会面临巨大的痛苦。同情慈悲是应对这些痛苦的重要工具。
  • 同情慈悲帮助我们接受生活中的苦难，学会以积极的方式应对挑战，而不是陷入自我批评和孤立。

• CFT的背景和目的

  • CFT是由保罗·吉尔伯特开发的，旨在帮助治疗师以非指责的方式理解来访的心理痛苦，并为他们提供有效的方法来应对这种痛苦。
  • CFT最初是为了帮助那些倾向于羞耻和自我批评的患者而开发的，这些患者即使在参与基于证据的治疗方案（如CBT）时仍然难以应对治疗。

• CFT的科学基础

  • CFT结合了进化心理学、情感神经科学（特别是归属感的神经科学）、依恋理论、行为主义和认知行为疗法（CBT）以及支持正念和同情慈悲实践的有效性的文献。
  • CFT强调帮助来访以同情慈悲的方式应对困难，并提供有效的应对挑战情绪和情境的方法。

• CFT的具体应用

  • CFT已应用于多种心理问题，包括抑郁症、精神病、暴食症、焦虑症、愤怒、创伤、社交焦虑和人格障碍。
  • 通过CFT，患者可以学会以温暖、接纳和鼓励的方式应对自己的挣扎和他人的困境，帮助他们感到安全和自信地应对挑战性的情绪和生活困难。

• CFT的核心技术

  • CFT注重创建来访思维和情感之间的一致性，帮助患者在情感上感到安心。
  • CFT通过多种技术和方法，如正念练习、情感调节训练、认知重构等，帮助患者应对心理痛苦。

希望这些知识点能帮助你更全面地理解CFT的核心理念和实践方法，激发你进一步探索和应用这些技巧的兴趣。

进一步阐述的知识点

• CFT的独特之处

  • CFT与其他包含同情慈悲的疗法的主要区别在于，它帮助来访在进化的背景下理解他们的挑战，包括大脑如何进化以产生基本的动机和情绪、情绪在大脑中的动态以及塑造自我的社会因素，尤其是在生命的早期。
  • 这些因素都不是来访选择或设计的，但它们在来访的挣扎中起着巨大作用。通过理解这些因素，来访可以停止因无法控制的事情而自责和攻击自己，而是专注于建设更好的生活。

• 去羞耻化和责任建立

  • 在CFT中，去羞耻化的过程伴随着通过培养同情慈悲心来同时建立责任和情感勇气。患者学习如何利用进化的情绪调节系统，使自己在接近和主动应对生活挑战时感到安全和自信。
  • 通过具体的技巧，如意象、同情慈悲培养练习和同情慈悲推理的发展，患者被指导开发适应性的、同情慈悲的策略，以应对情绪、关系和困难的生活情境。

• CFT的科学基础

  • 支持CFT的证据基础有两个方面：一是越来越多的研究支持CFT干预的有效性；二是几项基础文献提供了CFT理论及其治疗过程层面成分的科学依据。
  • CFT基于进化心理学、情感神经科学、依恋理论等领域的研究成果，强调帮助来访理解情绪和动机的进化背景，以及社会因素对自我形成的影响。

• CFT的有效性

  • 目前支持CFT干预有效性的研究虽然规模较小，但正在迅速增长。研究表明，CFT可以帮助减少自我批评、羞耻、压力、抑郁和焦虑。
  • 其他研究记录了使用CFT对患有精神障碍、饮食障碍、人格障碍、问题性愤怒和脑外伤的人的积极结果，以及在眼动脱敏和再处理治疗创伤时的结合使用。

• CFT的局限性

  • 支持CFT有效性的现有文献的主要限制是缺乏随机对照试验（RCTs）来证明其效果。尽管有少数RCT文章发表，但还需要更多高质量的临床试验来验证CFT的有效性。
  • 最近的一项系统综述得出结论，CFT在治疗心理障碍方面显示出前景，尤其是对高度自我批评的个体，但指出在做出CFT是一种基于证据的治疗方法的明确声明之前，还需要更多高质量的临床试验。

希望这些知识点能帮助你更全面地理解CFT的核心理念和实践方法，激发你进一步探索和应用这些技巧的兴趣。

进一步阐述的知识点

• CFT的科学基础

  • CFT的科学基础广泛而多样，涵盖了情感和归属感的神经科学、基本进化情绪调节系统的存在和动态、通过依恋关系的社会塑造自我等多个领域。
  • CFT不仅借鉴了行为主义和认知科学，还借鉴了社会情绪调节的科学和正念、心智化等治疗策略的实证研究。

• CFT的实践目标

  • CFT的实践目标是帮助来访建立和发展两个共同主题：对自己和他人的同情慈悲，以及培养一系列应对痛苦的同情慈悲能力。
  • 通过分层的过程和实践，CFT旨在帮助来访从以威胁为中心的生存方式转向一种善良、智慧、自信的视角，这种视角依赖于一系列有效的技能，直接而勇敢地应对生活挑战。

• 分层的过程和实践

  • 治疗关系：建立无条件温暖的治疗关系，帮助来访感到安全，体验到来自治疗师的同情慈悲。
  • 同情慈悲的理解：帮助来访以非指责、同情慈悲的方式理解他们的情绪和生活经历，认识到这些经历是如何被他们没有选择或设计的力量（如进化、社会塑造及其互动）所塑造的。
  • 正念觉知：帮助来访提高对情绪、思想和动机的觉知，避免常见的正念学习障碍。
  • 同情慈悲的实践：培养从自我批评转变为同情慈悲视角的动力，发展同情慈悲自我，培养同情慈悲思考和推理，使用同情慈悲意象来自我安抚，通过椅子工作和换位练习来强化同情慈悲自我。

• CFT的综合性和创新性

  • CFT不仅仅是一个简单的认知行为疗法加上一些佛教的同情慈悲实践。它是一个综合性的模型，通过分层构建一个互动的过程集，包括滋养关系、深刻的理解、深化的觉知和有目的的同情慈悲力量的培养。
  • 这种综合性方法旨在帮助来访从以威胁为中心的生存方式转向一种更健康、更积极的视角，这种视角依赖于一系列有效的技能，直接而勇敢地应对生活挑战。

希望这些知识点能帮助你更全面地理解CFT的核心理念和实践方法，激发你进一步探索和应用这些技巧的兴趣。

进一步阐述的知识点

• CFT与进化论的关系

  • CFT的一个独特之处在于它从进化的角度考虑人类的情绪、动机和行为。这种理解有助于促进对自己和他人的同情慈悲，因为从进化历史来看，这些体验在我们身上的表现是有道理的。
  • 虽然进化论在CFT中占有重要位置，但治疗师不应强行改变来访的宗教信仰或观点。相反，可以通过灵活的方式处理这一问题，确保治疗的顺利进行。

• 处理不相信进化论的来访

  • 尊重来访的信仰：治疗师应明确表示尊重来访的信仰，不会试图改变他们的宗教信仰。
  • 调整语言和视角：可以软化或省略跨物种进化的语言，强调人类内部的适应性。例如，可以提到某些特质对祖先可能非常有用，尽管这些特质在现代社会的表现方式可能不太合适。
  • 寻找共同点：即使来访不相信进化论，他们也可能愿意考虑人类历史中某些时期内的适应性变化。这有助于来访理解他们的情绪和行为模式。

• 沟通技巧

  • 诚实沟通：明确告知来访治疗中会涉及进化论的内容，并询问来访的看法。
  • 提供选择：让来访选择是否接受这些观点，或者只关注对他们有用的部分。
  • 灵活应对：如果来访对某个话题感到不适，可以调整讨论的方向，确保治疗的顺利进行。

• 实际案例

  • 治疗师可以通过具体对话示例来展示如何处理不相信进化论的来访。例如，治疗师可以解释进化论在理解情绪方面的科学依据，同时尊重来访的信仰，提供替代的解释方式。

希望这些知识点能帮助你更全面地理解CFT在处理不相信进化论的来访时的策略和方法，激发你进一步探索和应用这些技巧的兴趣。

进一步阐述的知识点

• CFT与其他疗法的兼容性

  • CFT与其他治疗模型高度兼容，可以作为一种补充而非替代的方法。
  • CFT强调同情慈悲和从进化的角度理解人类问题，这些特点使其在技术层面提供了许多新的治疗工具，同时也保留了一些与其他疗法相似的元素。

• CFT的技术特点

  • CFT依赖行为原则，不试图改变有问题的认知和情绪的内容，而是改变我们与这些心理体验的关系。
  • 正念在CFT中扮演着重要角色，体验重点和视角转换练习是其核心组成部分。
  • CFT特别关注如何帮助来访处理进化的情感系统，以创造安全感，并培养同情慈悲心，从而增强他们应对痛苦的能力。

• 个人实践的重要性

  • 个人实践对于理解同情慈悲、正念和安全感至关重要。通过亲身体验，治疗师可以获得更深层次的理解，包括细微差别、潜在障碍以及如何克服它们。
  • 本书包含了许多体验练习，鼓励读者在尝试这些练习之前先自己实践。

• 动机和意图的培养

  • 动机和意图是影响治疗效果的重要因素。CFT强调培养一种善良、坚定的动机，以帮助来访处理痛苦。
  • 通过具体的练习，治疗师可以引导自己和来访培养这种动机，从而更有效地进行治疗。

希望这些知识点能帮助你更全面地理解CFT的核心理念和实践方法，激发你进一步探索和应用这些技巧的兴趣。

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.