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193C H A P T E R 15 Riding the Third Wave: Integrating CFT into Your Therapy This is an exciting time to be a mental health professional. Recent decades have proven revolution- ary in terms of how quickly we’re learning new things about how human beings work. Even as we’ve only explored the tip of the iceberg, the rapidly growing bodies of research in neuroscience, behav- ioral science, and emotion are allowing the beginnings of a truly integrative understanding of human functioning. CFT seeks to represent this evolved, integrated understanding of what it means to be a human being, and to translate this science into powerful, practical methods for helping people turn toward their struggles with warmth and acceptance, and work with these struggles effectively. WHAT DOES A CFT THERAPIST LOOK LIKE? In approaching this book, I’ve attempted to emphasize the aspects of CFT that distinguish it from other therapies. Particularly in a “Made Simple” book, space prohibits me from exploring much more than the basic elements of the therapy. This is why I’ve generally chosen not to cover even compassion interventions that, while entirely CFT-­consistent, are well covered in other places (such as in Kristin Neff and Chris Germer’s excellent Mindful Self-­Compassion program; Neff & Germer, 2013). While reading the various case vignettes in the book, you may have had questionsCFT Made Simple like, “Would a CFT therapist use exposure therapy with this patient?” “What about social skills training, activity scheduling, and behavior activation?” “Would a CFT therapist prompt a client to explore her values?” The answer to all of these questions is a resounding “Yes!” A core value CFT therapists hold is that we don’t ignore good science. What this means is that CFT is constantly evolving from both a theoretical and a practice perspective. For example, over the past few years, we’ve placed increasing emphasis on breath and body work in consideration of Stephen Porges’ excellent work on polyvagal theory (e.g. Porges, 2011) and other research demon- strating the power of engaging the parasympathetic nervous system. Applications of CFT have been developed that consider the new science of memory reconsolidation (Monfils, Cowansage, Klann, & LeDoux, 2009; Schiller et al., 2010) in applying Compassionate Self work within exposure therapy (Kolts, Parker, & Johnson, 2013). My friends and colleagues Dennis Tirch, Benji Schoendorff, and Laura Silberstein have worked to integrate the compassion focus of CFT with the theoretical perspective of acceptance and commitment therapy, or ACT (Tirch, Schoendorff, & Silberstein, 2014). And I’m increasingly intrigued by the implications of relational frame theory (Hayes, Barnes-­ Holmes, & Roche, 2001) for understanding the nuances of threat system processing in CFT. When one hears the word “compassion,” one doesn’t necessarily think empiricism. But from the perspective of CFT, one of the most compassionate things we can do is to get better and better at really understanding the sources and dynamics of human suffering, and do a better and better job at researching and refining powerful ways to help alleviate and prevent it. Compassion is about helping effectively, not just about feeling helpful. In this way, science is core to compassion, and the CFT therapist is likely to draw upon any tools that have good science behind them. So if you want to do CFT, you don’t have to give up any of the things you already do that work. What may change, however, is how you do them. Because CFT is rooted in compassion. This emphasis should be present in all aspects of the therapy—­the way the therapist relates to the client, and how we help clients relate to themselves, and to others. Rooted in our understanding of under- lying affective systems, this means that CFT will always contain warmth (expressed in ways that work for the client), an emphasis on assisting clients to relate to their experiences with understand- ing and kindness rather than shame, a focus on helping clients learn to create feelings of safeness in themselves, and the development of the emotional courage to approach and work with the things that really scare them. Like ACT, CFT isn’t about moving away from feelings and experiences that make us uncomfortable. It’s about moving toward effective, compassionate ways of being in our minds and in the world, and even moving toward the things that bother us, so that we can compas- sionately work with them. So whatever we’re doing in CFT, there is always an emphasis on warmth, understanding, safeness, and courage. CFT AND OTHER MODELS In writing this book, it wasn’t my intention to convert therapists to CFT, but to provide you with compassionate perspectives, understandings, and tools that you can use to further develop your 196Riding the Third Wave: Integrating CFT into Your Therapy effectiveness as a therapist, regardless of your existing modality. As you may have noticed, CFT has a good deal in common with some other therapy approaches. While I’ve discussed some of the common ground between CFT and approaches such as ACT, DBT, and EFT, those of you with different therapeutic backgrounds may notice similarities with other models as well—­attachment therapy approaches, schema therapy, and even newer psychodynamic approaches spring to mind, for example. It’s my hope that practitioners from many other traditions will find something here to deepen their existing therapy practices, particularly in helping clients relate warmly and compas- sionately to themselves, to their problems, and to other people. In considering where CFT interfaces theoretically with other approaches, I see it falling within the “third wave” of behavior therapies, with an emphasis on changing one’s relationship to uncom- fortable thoughts and emotions (rather than trying to get rid of them), the cultivation of mindful- ness, and a priority placed on helping people build adaptive, meaningful lives (versus simply reducing symptoms). While it’s a bit more of a stretch, I also see CFT generally fitting alongside therapies like ACT and functional analytic psychotherapy (FAP) within the realm of contextual behavioral science (CBS). The philosophical core of CBS—­functional contextualism—­involves understanding that the function of a behavior (which can include thoughts and perhaps even emotions and motives) must be understood within the context in which it occurs. In understanding human functioning, CFT expands the meaning of “context” from strict behavioral terms to include the neurological contexts that influence affect, cognition, and behavior, as well as the evolutionary contexts that have shaped how emotions, motivations, and their behavioral manifestations play out in our lives. This is both a strength and a weakness of the CFT approach, depending upon one’s perspec- tive. It’s certainly a trade-­off. I think that considering the evolved functions of emotions and motives and having a neuroscience-­based understanding of the ways emotions operate in our brains and bodies has tremendous power in helping to deshame the challenges faced by our clients. Understanding why and how our emotions play out the way they do—­and that this is not our fault (as we didn’t design these processes)—­can be quite powerful in helping people stop beating them- selves up for their own experiences and learn to work with these experiences effectively. However, the intellectually honest CFT practitioner must admit that drawing upon such expla- nations comes with sacrifices, from the standpoint of strict empiricism. Behaviorists would note that ontological statements about the evolutionary origins and evolved functions of emotions and motives in large part defy empirical observation, and they’d be right. It’s fair criticism. In weighing these issues for myself, I’ve concluded that the trade-­off is worth it. I think the benefits of considering the functions and dynamics of our emotions and motives within evolution- ary and neurological, as well as behavioral, contexts (as best we understand them), justify this compromise—­if we keep a steady eye to the science. The Dalai Lama is well known for having said, “If science disproves some aspect of Buddhism, then Buddhism must change.” The same can and should be said for CFT, or, I would argue, for any approach that aspires to be empirically based. To the extent that an approach extends beyond tenets that have been established through solid, observable science, that approach must be amenable to change based on new data. (Of course, the hope is that all approaches would be amenable to change based on new data.) Dogmatism benefits 197CFT Made Simple no one—­our patients least of all. Humility, on the other hand, offers the promise of approaches which can be continually refined in the service of doing an ever-­better job at eliminating and pre- venting human suffering. BRINGING CFT INTO YOUR THERAPY ROOM It’s my hope that you’ve found something useful in CFT, and want to begin bringing what you’ve learned into your therapy practice. One way to do this would be to select a clinical case and try to follow the progression I’ve attempted to lay out in this book—­incorporating the various layers of relationship, understanding, mindful awareness, and purposeful cultivation of compassion. If that feels like a lot, perhaps simply try to incorporate one or more of the elements you’ve found here that falls outside the things you normally do in therapy. Below, I’ve included a few suggestions about how you might begin to do this. Consider the Roles You Are Inhabiting as the Therapist We’ve discussed the various roles served by the CFT therapist—­teacher, facilitator of a process of guided discovery, secure attachment base, and model of the compassionate self. As we do therapy, we can consider the roles we are inhabiting, and how best to do that. What function are we serving within the context of the therapeutic relationship, and how can we use our presence to facilitate the goals and direction of the therapy? Perhaps try to pay a bit more attention to these roles, and consider whether doing so helps clarify questions in the therapy such as What should I do now? In this way, we can borrow from the Compassionate Self practice as we reflect on the thera- peutic work outside the session: when our clients throw us a curveball, we can consider—­from the perspective of the teacher, facilitator, secure base, or compassionate model—­How would I understand what is happening here? How might I respond? Occasionally Bring in the Evolutionary Model We don’t have to go into deep discussions of evolution—­in fact, those generally aren’t helpful. But helping people recognize the different things that happen to their minds and bodies when they feel threatened or driven versus when they feel safe can be helpful. Considering threat emotions as having evolved to help us protect ourselves can help clients understand why they get so “stuck” in these emotions. It’s no accident that these emotions narrow our attention, thinking, and mental imagery onto perceived sources of threat, and it’s certainly not the client’s fault that this happens. Learning that helping themselves feel safe reverses this process (facilitating more flexible attention and reasoning, reflective thinking, and prosocial tendencies) can improve client motivation around working with these emotions. Helping clients understand what to do and why or how it will be helpful can be very powerful in building their willingness to do something new. 198Riding the Third Wave: Integrating CFT into Your Therapy Use Socratic Dialogue to Undermine Self-­Attacking With or without going into the evolutionary model, we can use Socratic dialogue to help clients shift from shaming themselves for their internal experience to the awareness that there are many aspects of their lives that they neither chose nor designed—­things which are quite literally not their fault. • “What was your experience of that emotion? Did you choose to get angry/afraid/resent- ful there, or did those feelings just arise in your mind and body?” • “When did you learn that you        ? What experiences taught you that?” • “Given what we know about your/her/his background, does it make sense that you/she/ he would feel/think/experience things in this way?” • “When your self-­critic attacks you for         , how do you feel? What does it motivate you to do? What do you end up doing?” Questions like these can help clients begin to let go of the tendency to attack themselves for things they didn’t choose or design, and to understand their experiences and behaviors in the context of their lives. In other words, the questions set the stage for them to compassionately take responsibility for making their lives better. Use the Three Circles as a Facilitator for Mindfulness Clients who initially struggle with mindfully observing and accepting their thoughts and emo- tions can sometimes be helped by the simplicity of the three circles. I’ve had numerous clients who had great difficulty observing thoughts or labeling specific emotions, but who were able to con- sider which of those three circles was active at any given time. Combined with an understanding of how those circles organize our minds and bodies (for example, that threat emotions tend to narrow and focus attention and thinking, and safeness emotions lead to reflectiveness, flexibility, and pro- sociality), it can be a powerful thing for a client to learn to notice what circle am I in? As I’ve men- tioned, a former student of mine who was also a cheerleading coach came up with a pithy way to remember this: “When in doubt, circle out!” Use the Three Circles in Considering Your Interactions with the Client We can also “circle out” in the therapy room. I’ve found it can be useful to consider the three circles both in my treatment planning and in working with challenges that arise in therapy. For 199CFT Made Simple example, I roughly shoot for around a 3-­2-­2 safeness-­drive-­threat ratio in therapy: three parts safe- ness, two parts drive, two parts threat. My goal for the therapeutic environment is to create an experience of safeness for my clients that grows as they learn to create these experiences in them- selves. Good therapy also gets the drive system going—­inspiring and motivating clients to work for change in their lives. Finally, there will be a good bit of threat in the therapy if we’re working with real issues—­but the key is that there is a balance, with threat experiences evoked in an inten- tional manner so that they can be compassionately worked with. It’s not just about safeness—­we’re striving for a flexible, fluid balance in which different affective experiences and motivations can arise and be evoked as they serve the situation at hand. Together, we want to appropriately work with perceived threats, activate and maintain motivation around pursuing therapeutic goals, and create a context of safeness in which comfort can be experienced and questions of meaning and values can be reflected upon. Considering the three circles can also be helpful when we’re struggling in therapy or the rela- tionship doesn’t seem to be going as well as we’d like. Sometimes we’ll find that we’ve inadvertently become a threat cue for the client. We can think of countertransference in this way—­considering that perhaps our own threat or drive systems have been triggered by the client’s behavior, or some- thing about that client that triggers our own previous conditioning. We may observe that we’ve been so much in drive—­excited by our wonderful new treatment plan—­that we’ve left our client behind. When therapy seems to have hit a sticking point or there’s a rupture in the therapeutic relationship, considering the situation in terms of the three circles either on our own or together with the client can sometimes shed light on the challenge and provide direction: • Which circle am I triggering in my client? Which do I want to be triggering? • Which circle has been running the show for me? • What would help to bring balance to both me and the client as we work with this situation? Sometimes, simply naming the situation and slowing things down to have a process-­level dis- cussion of how things have been playing out in the session can be a great help. The three circles can help us do this in a compassionate way: “Looks like our threat circles have been bouncing off of one another. This happens sometimes when dealing with real-life issues. Let’s take a minute to do some soothing rhythm breathing and consider how we want to proceed.” Use the Perspective of the Compassionate Self One nice thing about the Compassionate Self practice is that once this kind, wise, courageous perspective has been established, we can use it as an anchor-­point to facilitate other aspects of the therapy. Let’s consider just a couple of examples: 200Riding the Third Wave: Integrating CFT into Your Therapy THE COMPASSIONATE SELF AS AN ANCHOR-­POINT There’s a growing appreciation of the value of behavioral activation in creating emotional change. Simply getting clients moving in the direction of value-­based goals (a major focus of ACT) can be tremendously powerful, and most good treatment protocols for problems of anxiety and depression involve mobilizing client behavior to help them address life areas they may have been avoiding. This can be challenging with clients who struggle with motivation, perhaps because they are deeply entrenched in avoidance, habitually procrastinate, or are very depressed. Therapists who take it upon themselves to be “motivator in chief” can inadvertently set up a coercive environ- ment in therapy that can disempower clients or even invite them to resist the therapist’s efforts to get them moving. However, once such clients have connected with the perspective of the compas- sionate self, this perspective can be useful in shifting the role of motivator from the therapist to the client. “What does your compassionate self know that you need to do?” “If that kind, wise, coura- geous version of you were here, what home practice would she assign?” Questions like these can help clients shift from a perspective of avoidance and resistance to one that is driven by intuitive wisdom about what they really need to work on—­in a way that also helps them empower them- selves by shifting into the perspective of the compassionate self, and acting from that perspective. THE COMPASSIONATE SELF IN EXPOSURE THERAPY Exposure therapy is historically one of the most effective treatment methods we have at our disposal, as well as one of the most avoided by clinicians. Because coming into contact with feared memories and situations can be quite an aversive experience for the client, it can be challenging for clinicians to motivate their clients and themselves to engage with exposure practices. However, there’s quite a lot of literature supporting exposure as a core component in the treatment of many different problems. In CFT, the compassionate self can be used both as a motivator to engage with exposure and as a means to make it more palatable to clients and therapists alike. First, the question “What does your compassionate self know that we need to do?” can be helpful in building motivation for the exposure. Many clients intuitively know (or can come to realize through Socratic exploration) that facing their fears is something they need to do to progress toward their goals. Additionally, some preliminary work has been done to incorporate Compassionate Self work into exposure therapy itself, with promising (albeit unpublished) preliminary results (Kolts, Parker, & Johnson, 2013). Over the years, various theorists have utilized the addition of imaginal elements to exposure therapy protocols. Recently, exciting new research on memory reconsolidation (e.g. Monfils, Cowansage, Klann, & LeDoux, 2009; Schiller et al., 2010) has demonstrated that exposure can be done in a way that not only adds new learning, but can produce alterations in original fear memories by considering certain time constraints, and adding in new, nonfearful elements during the expo- sure process. These researchers have observed that a “reconsolidation window” appears to open 201CFT Made Simple approximately ten minutes following an initial imaginal reexposure to a fear memory, during which time the fear memory itself becomes somewhat malleable. During this time, new elements can be introduced, allowing the “rewriting” of memories so that fear is no longer expressed (Schiller et al., 2010). In CFT, this can be done by having the client initially bring up a fear memory—­for example, an acute trauma memory or “hot spot” (particularly fearful piece of a longer trauma memory). The reconsolidation literature indicates that a period of ten minutes or so needs to pass between the initial recall of the fear memory and the point at which it becomes malleable to updating via new information. We can spend this time assisting the client to shift into the perspective of the compas- sionate self, say, by doing one minute of soothing rhythm breathing, five minutes of mindful breath- ing, and a five-­to seven-­minute Compassionate Self exercise (Kolts, Parker, & Johnson, 2013). Then, the client is instructed to return to the fear memory in standard fashion, keying into both the sensory aspects of the memory and the feelings and thoughts that are present. Once the memory is vivid, we can prompt clients to slow down their breathing, shift into the perspective of the compassionate self, and imagine that they are in the situation as their current, compassionate self—­observing the vulnerable version of themselves in the memory, feeling compassion for that scared version of themselves, and offering support and reassurance in whatever way would be expe- rienced as most helpful. Focus is placed on creating feelings of warmth, kindness, and a desire to help the suffering self, and on offering support and encouragement to this vulnerable self. “How would you support that vulnerable version of you?” “What would you want that vulnerable self to understand?” “How might you be there for her and encourage her?” Then the client can be prompted to shift back and forth between the perspective of the com- passionate self (now placed into the context of the memory) and the perspective of the vulnerable version of the self that experienced the event. The client imagines himself back in the situation, with all of the scary aspects of the event still present, but also having the future kind, wise, coura- geous version of the self there as well—­offering kindness, encouragement, support, and perhaps the certainty that you will make it through this, to become this future self. The therapy then progresses, shifting back and forth between these two versions of the self, using subjective distress ratings as anchor-points for tracking the client’s distress. While the efficacy of this variant of exposure therapy needs to be systematically evaluated through research, it is consistent with recent science on memory reconsolidation, and preliminary observations seem to indicate that it can significantly reduce client distress and avoidance while producing similar gains to traditional exposure therapies. These few cases have also demonstrated anecdotal evidence consistent with the reconsolidation studies, with clients saying things like, “The memory is still there, but instead of the fear that used to be there, there is an experience of being supported—­of not being alone” (Kolts, Parker, & Johnson, 2013). 202Conclusion Whether you picked up this book in the hope of learning to formally practice CFT as a cohesive therapy approach, or simply wanted to add some new tools and perspectives to your existing treat- ment approach, I hope you’ve found something of use. Compassion offers powerful tools for helping clients to overcome shame, and relate to their struggles with warmth, courage, encouragement, and the commitment to build better lives. I’ve attempted to organize and present CFT as a collection of layered processes and practices: the roles embodied in the therapeutic relationship; a compassionate understanding of the human condition based in an understanding of evolution, affective neuroscience, attachment, and behav- ioral science; the cultivation of a mindful awareness; and the purposeful development of compas- sion and compassionate strengths. When CFT is at its best, these various layers deepen, strengthen, and reinforce one another. While we can choose to select certain practices and techniques and use them in isolation, I’d encourage you to consider all of these layers, and how you might weave them into the therapy process. As we began, let’s end by reminding ourselves of the price of admission: if we’re going to have human lives, we’re going to face pain and suffering. We’ll all face difficulties, disappointments, chal- lenges, and grief. It’s understandable that we (and our clients) wouldn’t want to face these things—­ we’d often prefer to turn away and avoid the things that make us uncomfortable. But that doesn’t work, because in organizing our lives around minimizing discomfort, we shut ourselves off from many of the things that can make them deeply meaningful. We can build our lives around endless efforts to stay comfortable, or we can make them about pursuing goals and relationships that are deeply important to us and imbue us with meaning, safeness, fulfillment, and joy. But we can’t do both. Compassion gives us a way to turn toward the things that scare us—­with kindness, wisdom, and courage—­and to work with them. When we stop trying to avoid discomfort, we can turn toward suffering and look deeply into it, so we can come to understand the causes and conditions that create it—­perhaps even learning enough to help make things better.CFT Made Simple Perhaps most of all, compassion involves courage: the courage to let our hearts break. But here’s the thing: our hearts are going to break anyway. Bad things sometimes happen in life, and we all have to find ways to work with them. Remember, it’s the price of admission to have a human life. The question is this: What are we going to do when that happens? Will we close ourselves off, or open our- selves up? What if we accept this pain and occasional heartbreak as simply part of what it costs to have an amazing life? What if we consider what that kind, wise, courageous, compassionate version of us would do? What if we let ourselves care, connecting with likeminded others to support one another in the courageous work of making positive change in our lives, and in the world? Let’s keep our- selves pointed toward the things that are important to us, help our clients do the same, and keep going. This is compassion. 204Afterword: Unpacking the Compassionate Mind This book is a wonderful beginning guide to compassion-­focused therapy (CFT). CFT is part of a family of contextual forms of cognitive and behavioral therapy that are concerned with issues such as self-­kindness, compassion for others, mindfulness, and values-­based actions. The specific theo- ries and techniques that are part of these new methods vary, but they are clearly interconnected. Thus, even though I am not an expert in CFT, I am honored to have been asked to write a short afterword to this book, and it is those interconnections that I would like to focus on. I predict that evidence-­based therapies in general, and cognitive behavioral therapy (CBT) in particular, will soon be thought of more as comprising evidence-­based processes and procedures for solving problems and for promoting human prosperity, than as named packages of therapeutic techniques linked to syndromes and the elimination of symptoms. As that transition occurs, I expect that process-­oriented forms of contextual treatment will increasingly link a portion of their evidence-­based change principles to compassion as it’s considered from the point of view of more basic scientific areas including evolution, learning, emotion, cognition, and culture. Thus the core vision of CFT, in my opinion, is likely to have a very long life indeed. Through books like this, therapists can quickly see for themselves how central these issues are in therapy. They are central in part because of the modern world itself. The human mind did not evolve for the present day. Modern technology, gushing a constant stream of images and sound, has created a fire hose of human language. Everything imaginable is there in the stream, but theCFT Made Simple biases of commerce and media mean that messages conveying courage, love, and connection are simply being overwhelmed by those spreading pain, horror, criticism, and judgment. If it bleeds, it leads. Pain sells. There is, in effect, no place that the cacophony cannot reach. I am a few feet from a television remote, my iPhone is inches away, I’m typing on my laptop, and the newspaper sits on the floor next to my chair. Without so much as lifting my rear end from this chair I can tell you that the man who long represented Subway sandwich shops is going to jail for molesting children; that it has been one year since news correspondent James Foley was beheaded; that a baby boy died after his father was seen beating him in a car while driving; that July was the hottest month in recorded history; that a talk-show host wants to house undocumented immigrants in tents and rent them out as slaves; and that a fifty-­eight-­year-­old homeless Latino person was beaten and urinated on by men who said Donald Trump was right about immigrants. That is just one day, and I’ve hardly gotten started. Human beings are cooperative primates, and both the desire to be included and the effects of mentally including others are built into our bones, into our language systems, and into our cultures. Our ability to cooperate and to care about others is why we have a civilized society. It is why we even have television, or iPhones, or laptops, or newspapers. We should neither romanticize these abilities nor take them for granted. In order to have com- passion for others, we need to take their perspective and not run away when it is emotionally hard. At the same time, multilevel selection theory teaches us that we evolved to be cooperative in part because of between-­group competition. In the modern interconnected world, we can no longer rely on that mechanism—­being “for” our in-­group and “against” outsiders—­to foster compassion and concern. We need now to care about that much larger group called “humanity.” That can be a challenge to us all. If the core vision of CFT is here to stay, then it is up to evidence-­based therapists across the board to take that vision seriously. This means digging into the more specific predictions about processes of change, and their linkage to specific methods relevant to compassion, made by the contextual forms of CBT. We need to know, and soon, not just that compassion is important in a general sense, but how and why it is important in specific areas, and how best to target those areas. It will take a lot of cooperation and effort from a very large group to acquire that knowledge in detail and in a reasonable time frame. Those interested in compassion as a clinical issue and those practicing CFT will need to take part. For all of these reasons, a book like this is invaluable. It opens up CFT ideas to the larger thera- peutic community so that the involvement and interest in these issues and methods can continue to broaden and grow. In the modern world, compassion is too crucial for us to do anything else. —Steven C. Hayes Foundation Professor, University of Nevada, Reno Cofounder of ACT and author of Get Out of Your Mind and Into Your Life 206Acknowledgments First, sincere appreciation goes to my wife, Lisa Koch, and my son, Dylan Kolts, who never grum- bled when I snuck away to write on a weekend morning. Also to my parents, John and Mary Kolts, who offered continuous support and encouragement for this book as for all things. Thanks to all at New Harbinger who nurtured this book and me while I was writing it, includ- ing Tesilya Hanauer, Catharine Meyers, Nicola Skidmore, and Jess Beebe. Sincere thanks also to Susan LaCroix, whose copyediting made this a much better book. Paul Gilbert is the reason this book exists—­Paul, I hope I haven’t butchered your model too much! To credit Paul as he deserves would make for an impossibly cumbersome text, as virtually every page contains something I learned from Paul—­if not from his written works, then from eve- nings spent chatting about CFT over glasses of red wine and the occasional interlude to play guitar. Thanks also to my dear friends in the CFT community: Dennis Tirch, Laura Silberstein, Jean and the entire Gilbert family, Chris Irons, Korina Ioannou, Christine Braehler, Deborah Lee, Tobyn Bell, Fiona Ashworth, Michelle Cree, Kate Lucre, Corinne Gale, Mary Welford, Neil Clapton, Ken Goss, Ian Lowens, and many others. Sincere thanks also go to Matthieu Villatte for his valuable feedback on the sections regarding relational frame theory, and to the many others who contributed directly or indirectly to this book, including Susanne Regnier, Jason Luoma, Melissa Ranucci-­Soll, Kelly Koerner, Amy Wagner, Sandy Bushberg, and Kelly Wilson. I also want to acknowledge my wonderful colleagues and students at Eastern Washington University, who have supported and nurtured my career for going-on two decades now. In particu- lar, I’d like to recognize my department chair, Nick Jackson; my dean, Vickie Shields; and my dear friends and colleagues Phil Watkins, Amani El-Alayli, and Kurt Stellwagen. I also want to acknowl- edge the fantastic students in my research team, including Amy Frers, Leah Parker, Elijah Johnson, Ahva Mozafari, and Blaine Bart.Appendix: Reproducible Forms The following forms are also available for download at http://www.newharbinger.com/33094.210 Internal: Self as: Internal: External: Safety Strategies/ Defensive Behaviors Relating Self-to-Other: Self-to-Self: Internal: This worksheet was developed for the book CFT Made Simple, by Russell Kolts, based upon work by Paul Gilbert and the Compassionate Mind Foundation (http://www.compassionatemind.co.uk). Permission is granted for the free reproduction and dissemination of this form for clinical or training purposes. Others as: External: Key Fears Emotional/Shame Memories: Innate and Historical Influences External: Unintended Consequences CFT CASE FORMULATION WORKSHEET CFT Made SimpleAppendix: Reproducible Forms THREAT EMOTION MONITORING FORM The purpose of this homework is to help you become familiar with the situations that tend to provoke your anger and the ways in which you tend to respond, and to learn to generate compassionate alternatives. Pick one time during the week when you experienced a threat emotion, such as anger or anxiety. Situation/Trigger: Emotions: Thoughts: Behaviors (What did I do?): 211CFT Made Simple Outcome (How did the situation turn out?): What does my compassionate self say? What would my compassionate self have done? This worksheet was developed for the book CFT Made Simple, by Russell Kolts. Permission is granted for the free repro- duction and dissemination of this form for clinical or training purposes. 212Appendix: Reproducible Forms FILLING OUT THE THREAT EMOTION MONITORING FORM Situation/Trigger: Briefly describe what happened—­the situation that provoked your threat response. What threat was involved? Describe the context as well (I was late, and the people in front of me were…). Often, there are fairly consistent “triggers” that tend to activate us. It is important to identify what our specific triggers are—­what sorts of experiences tend to make us feel threatened—­so we can learn to work skillfully when faced with them. Emotions: What feelings came up in the situation? Use specific terms (anger, irritation, anxiety, loneliness, embarrassment, shame, fear, sadness, excitement). Thoughts: What words and images came up in your mind? (For example: She can’t treat me like that! or I can’t handle this.) Did your thoughts fuel or calm your threat system? Behaviors: What did you do? What actions did you take? Outcome: How did it turn out? What helped in this situation? What did you do that worked? What got in the way of your handling the situation the best way you could? What does my compassionate self say? How would your wise, kind, confident, compassionate self under- stand and approach this situation? What would my compassionate self have done? How would your compassionate self behave in this situation? 213CFT Made Simple INSTRUCTIONS FOR COMPASSIONATE LETTER-WRITING This exercise is designed to help us develop the compassionate self. We want to build and strengthen mental patterns that will help us find the courage to work with difficult experiences, to accept ourselves, and to build a sense of peace within ourselves that we can share with others. Learning to think and behave compassionately can sometimes be helped by writing a letter to ourselves. In this exercise, you’re going to write about difficul- ties, but from the perspective of your compassionate self. You can write a general letter to yourself, or you can tailor the letter to support yourself around a particularly challenging situation. 214 •First, get out a pen and paper. You might even pick out a special journal or notebook. •Spend a few moments doing soothing rhythm breathing. Allow yourself to slow down and settle into your experience. •Now try to shift into the perspective of your compassionate self. Connect with your compassionate self, imagining yourself at your best—your calmest, your wisest, your most caring, your most confi- dent and courageous. Feel yourself filled with feelings of kindness, strength, and confidence. Imagine yourself as this compassionate person who is wise, understanding, and committed to helping. Imagine your manner, your tone of voice, and how you feel as this compassionate being. •When we are in a compassionate frame of mind, even slightly, we try to use our personal life experi- ences wisely. We know that life can be hard. We can look deeply into the perspectives of ourselves and other people involved in difficult situations, and try to understand how it makes sense that they might feel and act this way. We offer strength and support, and try to be warm, nonjudgmental, and noncondemning. Take a few breaths and feel that wise, understanding, confident, compassionate part of you arise—this is the part of you that will write the letter. •If thoughts of self-doubt, like Am I doing it right? or I’m not really feeling it arise, note these thoughts as normal comments our minds make, and observe what you are experiencing as you write the best that you can. There is no right or wrong…you’re just practicing, working with your compassionate self. As you write, try to create as much emotional warmth and understanding as you can. •As you write your letter, try to allow yourself to understand and accept your distress. For example, you might start with, I am sad, and I feel distress. My distress is understandable because… •Note the reasons—realize that your distress makes sense. Then continue… I would like myself to know that… •The idea is to communicate understanding, caring, and warmth while helping ourselves work on the things we need to address.Appendix: Reproducible Forms When you have written your first few compassionate letters, go through them with an open mind and see whether they actually capture compassion for you. If they do, see if you can spot the following qualities in your letter: •It expresses concern, genuine caring, and encouragement. •It is sensitive to your distress and needs. •It helps you face your feelings and become more tolerant of them. •It helps you become more understanding of your feelings, difficulties, and dilemmas. •It is nonjudgmental and noncondemning, helping you to feel safe and accepted. •A genuine sense of warmth, understanding, and caring fills the letter. •It helps you think about behavior you may need to adopt in order to get better. •It reminds you why you are making efforts to improve. This handout was developed for the book CFT Made Simple, by Russell Kolts. Permission is granted for the free reproduction and dissemination of this form for clinical or training purposes. 215CFT Made Simple COMPASSION PRACTICE JOURNAL Day Type of Practice and How Long Comments—­What Was Helpful? Monday Tuesday Wednesday Thursday Friday Saturday Sunday This worksheet was developed for the book CFT Made Simple, by Russell Kolts. Permission is granted for the free repro- duction and dissemination of this form for clinical or training purposes. 216References Ainsworth, M. D. S. (1963). The development of infant-­mother interaction among the Ganda. In B. M. Foss (Ed.), Determinants of Infant Behavior, Vol. 2, 67–­112. New York: Wiley. Andrews, B., Brewin, C. R., Rose, S., & Kirk, M. (2000). Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse. Journal of Abnormal Psychology, 109, 69–­73. Andrews, B., & Hunter, E. (1997). Shame, early abuse, and course of depression in a clinical sample: a preliminary study. Cognition and Emotion, 11, 373–­381. Andrews, B., Quian, M., & Valentine, J. (2002). Predicting depressive symptoms with a new measure of shame: the Experiences of Shame Scale. British Journal of Clinical Psychology, 41, 29–­33. 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R. (2014). The ACT Practitioner’s Guide to the Science of Compassion: Tools for Fostering Psychological Flexibility. Oakland, CA: New Harbinger. Törneke, N. (2010). Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application. Oakland, CA: New Harbinger; Reno, NV: Context Press. Tsai, M., Kohlenberg, R. J., Kanter, J., Kohlenberg, B., Follette, W., & Callaghan, G. (2009). A Guide to Functional Analytic Psychotherapy: Awareness, Courage, Love and Behaviorism. New York: Springer. Wallin, D. J. (2007). Attachment in Psychotherapy. New York: Guilford Press. 221About the author Russell L. Kolts, PhD, is a licensed clinical psychologist and professor of psychology at Eastern Washington University, where he has taught for the past seventeen years. Kolts has authored or coauthored numerous books and scholarly articles, including The Compassionate-­Mind Guide to Managing Your Anger, and has pioneered the application of compassion-­focused therapy (CFT) to the treat- ment of problematic anger. An internationally recognized expert in CFT, he regularly conducts trainings and workshops on compassion and CFT, and has appeared in his own TEDx Talk. Foreword writer Paul Gilbert, PhD, is world-­renowned for his work on depression, shame, and self-­ criticism, and is the developer of CFT. He is head of the mental health research unit at the University of Derby, and has authored or coauthored numerous scholarly articles and books, including The Compassionate Mind, Mindful Compassion, and Overcoming Depression. Afterword writer Steven C. Hayes, PhD, is Nevada Foundation Professor and director of clinical training in the department of psychology at the University of Nevada. An author of forty-­one books and nearly 600 scientific articles, his career has focused on analysis of the nature of human language and cognition, and its application to the understanding and alleviation of human suffering and promotion of human prosperity. Among other associations, Hayes has been president of the Association for Behavioral and Cognitive Therapy, and the Association for Contextual Behavioral Science. His work has received several awards, including the Impact of Science on Application Award from the Society for the Advancement of Behavior Analysis, and the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapy.Index AB A-­B-­C process, 80 about this book, 5–­7 acceptance and commitment therapy (ACT), 10, 91, 196, 197 activity scheduling, 123 affect: practice for exploring, 181–­193. See also emotions affective neuroscience, 19, 53, 61, 197 affiliation contexts, 20 amygdala, 52, 63, 64 anger, 153, 159, 183–­186 antecedents to behavior, 80 anxiety, 77, 187–­188 archetypal motives, 52 attachment: aversion and, 64; history and style of, 76–­79 attachment anxiety, 77 attachment avoidance, 77 attachment behavioral system, 40 attachment security, 77 attachment theory, ix, 40 attention: focusing in a soothing way, 59; mindfulness and, 29–­30, 93–­94 aversion, 64, 82 avoidance: attachment, 77; of mindfulness practice, 103–­104; safety strategies and, 176; shame-­related, 15 awareness, compassionate, 91–­105. See also mindfulnessbehavior: compassionate, 30–­31; defensive, 175–­176; functional analysis of, 80–­82 behavior therapy, 80–­87 behavioral activation, 201 beliefs of clients, 7–­10 Bell, Tobyn, 182 biological influences, 173 body: practicing mindfulness of, 102; soothing rhythm breathing and, 57–­59 Bowlby, John, 40, 76 brain: challenges of our evolved, 18; evolutionary shaping of, 49–­59; exploring the old vs. new, 50–­56; parts of the triune, 49–­50. See also mind breathing: mindful, 57–­58, 97–­102; soothing rhythm, 30, 57–­59 Burns, David, 174 C captain of the ship metaphor, 183, 190, 192 cardboard cutout metaphor, 131–­132, 133 case formulation, 171–­179; description of components in, 171; innate and historical influences in, 173; key fears explored in, 173–­175; patterns of self and other relating in, 177; safety strategies recognized in, 175–­176; treatment planning based on, 179; unintended consequences explored in, 176–­177; worksheet for CFT, 172, 178, 210CFT Made Simple cerebral cortex, 50 CFT. See compassion-­focused therapy CFT Case Formulation Worksheet, 172, 178, 210 chair work, 155–­170; benefits of, 155; empty-­chair work, 156–­159; Multiple Selves practice and, 181; two-­chair work, 159–­170 Circle of Compassion, 27 coercive environment, 201 cognitive behavioral therapy (CBT), 205 colleague consultations, 48 common humanity, 42, 47 compassion: attributes of, 26–­29; building blocks of, 17–­19; CFT as rooted in, 196; circle of, 27; connecting with qualities of, 44; cultivation of, 43–­44; definition of, viii, 16–­17, 25–­26; extending to vulnerable self, 119–­123; fears of, 41, 87–­89; flow of, 152; skills related to, 29–­31 compassion for others practice, 153–­154 Compassion for Voices (film), xi Compassion Practice Journal form, 216 compassionate action, 30 compassionate awareness, 91–­105 compassionate behavior, 30–­31 compassionate correction, 16 compassionate imagery. See imagery compassionate letter-­w riting, 124–­127; example letter, 126; instructions for, 124–­126, 214–­215 Compassionate Mind, The (Gilbert), 43 Compassionate Mind Foundation, 36, 172 compassionate motivation, viii, 12, 28 compassionate self, 7, 115–­127; captain of the ship metaphor and, 183, 190, 192; chair work with, 156, 159–­170; example dialogue on practicing, 116–­119; exposure therapy and, 201–­202; helping clients cultivate, 17, 115–­127; home practice of, 123–­124; imagery practices based on, 152–­153; letter-­ writing exercise for, 124–­127; loving-­kindness meditation and, 153; method-­acting approach to developing, 116; modeling in therapy, 41–­44; motivation and, 201; strengthening the perspective of, 123–­124; therapeutic perspective using, 200–­202; vulnerable or suffering self and, 119–­123. See also self-­compassion Compassionate Self practice, 30, 43, 116–­119, 123, 127 226 compassionate thinking and reasoning, 29, 129–­140; compassionate understanding linked to, 135–­139; examples of working with, 131–­134, 136–­139; importance of mindfulness for, 130; mentalizing for, 135; threat-­based thinking vs., 134–­135 compassionate understanding: of the evolution of our brains, 49–­59; of the social shaping of the self, 75–­89; thought work linked to, 135–­139; of the three types of emotion, 61–­73 compassion-­focused therapy (CFT): approach of, 3–­4; case formulation in, 171–­179; chair work in, 155–­170; characteristics of, 195–­196; compared to other approaches, 196–­198; core ideas of, 14–­23; evidence base for, 4–­5, 205, 206; general description of, 2–­3; integrating into your practice, 10–­11, 198–­202; layered approach to, 5–­7; origins of, 13–­14; roles of the therapist in, 33–­47, 198; scientific basis of, 5; unique features of, x–­xi competitive social rank, xi conditioning: operant, 80–­82; respondent, 82–­83 consequences: of behavior, 81; unintended, 176–­177 contextual behavioral science (CBS), 197 coping strategies, 30 core fears/threats, 173–­175 countertransference, 200 courage, vii, 26, 42 credibility, therapist, 35 D Dalai Lama, 197 debriefing exercises, 192–­193 defensive behaviors, 175–­176 derived relationships, 84–­85 dialectical behavior therapy (DBT), 10, 43, 91 discriminative stimuli, 80 distress tolerance, 28, 163 downward arrow method, 174–­175 drive system: explanation of, 63–­64; inspiring through therapy, 200 E eating mindfully, 102 emotional brain, 50, 52 emotional courage, 26, 42Index emotional inertia, 57 emotional tone, vii–­viii emotion-­focused therapy (EFT), 10, 155, 163 emotion-­regulation systems, ix, 19–­20; evolution of, 52; three-­circles model of, 62–­65 emotions: breathing and, 57, 59; care-­oriented, viii; chair work for working with, 155; compassionate feelings and, 30; evolutionary function of, x, 18; mindful awareness of, 92–­93; Multiple Selves practice and, 181–­193; organization of mind and, 65–­71; shown by therapists, 151; threat, 20, 35, 63; three types of, ix, 61–­73; understanding vs. judging, 56 empathy, 29 empiricism, 196, 197 empty-­chair work, 156–­159 environments: childhood development and, 75; goal for therapeutic, 200; insecure or invalidating, 20 evidence base for CFT, 4–­5, 205, 206 evolution: CFT approach and, 3, 8, 197; client beliefs about, 7–­10; cognitive challenges related to, 18; teaching clients about, 35, 198 evolutionary functional analysis, ix, 35, 61 exercising mindfully, 102 experience: case formulation related to, 173; emotions and the organization of, 65–­71 experiential avoidance, 14 experiential exercises, 11, 38; Compassionate Letter-­ Writing, 124–­127, 214–­215; Connecting with Compassionate Qualities, 44; Ideal Compassionate Image Practice, 147–­151; Mindful Checking-­In, 94–­97; Multiple Selves practice, 181–­193; Soothing Rhythm Breathing, 58; Two Teachers vignette, 110–­113; Working with Motivation and Intention, 11–­12 exposure therapy, 11, 196, 201–­202 external shame, 14, 23 external threats, 173 F failure, feelings of, 104–­105 fears: of compassion, 41, 87–­89; exposure therapy for, 201–­202; identifying key, 173–­175 feelings: cultivating compassionate, 30; mindful awareness of, 92–­93. See also emotions flow of compassion, 152 forgetting to practice, 103 forms, 209–­216; CFT Case Formulation Worksheet, 172, 178, 210; Compassion Practice Journal, 216; Instructions for Compassionate Letter-­Writing, 214–­215; Threat Emotion Monitoring, 124, 211–­212, 213 frozen prawns metaphor, 88 functional analysis of behavior, 80–­82 functional analytic psychotherapy (FAP), 10, 35, 197 functional contextualism, 197 G Germer, Chris, 195 Gibran, Kahlil, 1 Gilbert, Paul, xii, 2, 5, 13, 59, 72, 141, 172, 181 Good Will Hunting (film), 19 Greenberg, Leslie, 155 guided discovery, 37–­39; experiential exercises for, 38; exploring interpersonal dynamics for, 38–­39; Socratic dialogue for, 37–­38; working with obstacles for, 39 H Hayes, Steven C., 206 heartfelt motivation, viii helpfulness, viii, 29 historical influences, 173 home practice: compassionate self, 123–­124; soothing rhythm breathing, 59; supplementary materials for, 36–­37; threat emotion monitoring, 124, 211–­213 humility, 198 I imagery, 30, 141–­154; compassion for distress, threat feelings, and pain practice, 152; compassion for others practice, 153–­154; compassion for the self practice, 152–­153; exposure therapy using, 201; introducing clients to, 141–­143; perfect nurturer practice, 147–­151; safe place created with, 143–­147 implicit processing systems, 52 innate influences, 173 Inside Out (film), x 227CFT Made Simple Instructions for Compassionate Letter-­Writing (form), 214–­215 intention, exercise on working with, 11–­12 internal affiliative relationship, x internal shame, 14, 23 internal threats, 173, 175 internal working models, 40, 173 interpersonal dynamics, 38–­39 invalidating environments, 20 J judging thoughts/emotions, 56 K Kabat-­Zinn, Jon, 92 key fears, 173–­175 L layered processes and practices, 5–­7 learned responses, 30 learning: prepared, 83; social, 85–­87 learning theory, 80–­87 Lee, Deborah, 147 letter-­w riting. See compassionate letter-­w riting lifestyles, compassionate, 115 lightheartedness, 43 limbic system, 49–­50 loving-­kindness practices, 153–­154 M Maclean, Paul, 49 maladaptive consequences, 176 memories: case formulation drawing on, 173; emotions shaped by, 71; exposure therapy and, 201–­202; reconsolidation of, 196, 201–­202 mental experiences, 141. See also imagery mental “palate cleanser,” 183, 186, 191 mentalizing, 135 metaphors: captain of the ship, 183, 190, 192; cardboard cutout, 131–­132, 133; frozen prawns, 88; path in the woods, 136–­138 method-­acting approach, 116 Mikulincer, Mario, 40 228 mind: emotions and the organization of, 65–­71; mindfully noticing movement in, 105. See also brain mindful breathing, 97–­102; soothing rhythm breathing vs., 57–­58; teaching to clients, 98–­101; therapist practice of, 102 Mindful Checking-­In exercise, 94–­97 Mindful Compassion (Gilbert and Choden), 43 Mindful Self-­Compassion program, 195 mindful task completion, 102 mindfulness, 91–­105; attention and, 29–­30, 93–­94; benefits of practicing, 92–­93; breathing based on, 97–­102; Checking-­In exercise, 94–­97; common activities utilizing, 102–­103; compassionate thought work and, 130; definition of, 92; facilitating with the three circles, 199; obstacles to practicing, 103–­105; preparing clients for, 93–­94 mindfulness-­based cognitive therapy (MBCT), 10, 91 motivation: brain evolution and, 52; compassionate, viii, 12, 28, 201; exercise on working with, 11–­12; guiding force of, xi; mindfulness practice and, 103–­104; self-­criticism used for, 163; social mentalities and, 72–­73 Multiple Selves practice, 181–­193; captain of the ship metaphor and, 183, 190, 192; debriefing with clients, 192–­193; example dialogue illustrating, 183–­191; explanation of, 181–­182; potential objectives of, 182; tips for facilitating, 182–­183 N Neff, Kristin, 42, 195 negative punishment, 81 neo-­mammalian brain, 50 neuroscience, affective, 19, 53, 61, 197 New Harbinger website, 36 nonjudgment, 28 O obstacles: in mindfulness training, 103–­105; working collaboratively with, 39 old vs. new brain, 50–­56 operant conditioning, 80–­82 organization of experience, 65–­71; compassionate mind and, 130; safeness system and, 68–­71; threat system and, 65, 66–­68, 130Index other-­directed compassion, 153–­154 other-­schemas, 173 P paleo-­mammalian brain, 49 parasympathetic nervous system, ix, 196 path in the woods metaphor, 136–­138 peer-­supervision process, 48 perfect nurturer practice, 147–­151 phrases, compassionate, 152–­153 polyvagal theory, 196 Porges, Stephen, 196 positive punishment, 81 prepared learning, 83 present-­moment affective work, 35 progressive muscle relaxation, 59 Prophet, The (Gibran), 1 punishment, 81 R randomized controlled trials (RCTs), 4 reasoning, compassionate, 56, 103, 134–­135. See also compassionate thinking and reasoning reconsolidation of memories, 196, 201–­202 reinforcement, 81 relational frame theory (RFT), 84–­85, 196 relational safeness, 31 relationships: affiliative, x; derived, 84–­85. See also therapeutic relationship relaxation exercises, 58–­59 reptilian brain, 49 respondent conditioning, 82–­83 response cost, 81 roles of CFT therapist, 33–­47; considering the functions of, 198; facilitator of guided discovery, 37–­39; model of compassionate self, 41–­44; provider of secure base, 40–­41; putting into play with clients, 44–­47; teacher of CFT model, 34–­37 S sadness, 72, 188 safe haven, ix safe place imagery, 143–­147 safeness: creating feelings of, 19–­23, 200; emotion-­ regulation system for, 64–­65; imagery practice for, 143–­147; secure base related to, 40–­41; social connectedness and, 64–­65; therapeutic environment of, 31 safeness system: explanation of, 64–­65; organization of the mind and, 68–­71 safeness-­drive-­threat ratio, 200 safety strategies, 77, 175–­177; recognizing in clients, 175–­176; self and other relating and, 177; unintended consequences of, 176–­177 Schoendorff, Benji, 196 secure attachment, 77 secure base, ix, 40–­41 self: different versions of, 76; emotions and the organization of, 68; multiple versions of, 181–­193; practicing compassion for, 152–­153; social shaping of, 18–­19, 75–­89 self-­attacking, 199 self-­compassion: chair work for experiencing, 159; common humanity as core component of, 42, 47; imagery practice for developing, 152–­153; Two Teachers vignette for developing, 110–­113; understanding as foundational layer of, 89. See also compassionate self self-­criticism, 107–­113; chair work for, 155, 156, 159, 163–­170; crippling effect of, 14–­16; discovering the motivation behind, 163; Socratic dialog for exploring, 108–­110, 112–­113, 163; Two Teachers vignette on, 110–­113 self-­disclosure, 47–­48 self-­harm, 176 self-­schemas, 173 self-­stigma, 15 sensitivity, 27 sensory anchors, 146 sensory focusing, 30 sexual fantasies, 52 shame: crippling effect of, 14–­16; internal vs. external, 14, 23; process of overcoming, 3 Shaver, Philip, 40 showering mindfully, 102 Silberstein, Laura, 196 slowing, creating a sense of, 58 229CFT Made Simple social experiences: safeness system related to, 64–­65; the self shaped through, 18–­19, 23 social influences, 173 social learning, 85–­87 social mentalities, 72–­73, 115 social shaping of the self, 18–­19, 76–­87; attachment history/style and, 76–­79; learning theory/behavior therapy and, 80–­87 Socratic dialogue, 37–­38; safety strategies and, 176; self-­criticism and, 108–­110, 112–­113, 163; undermining self-­attacks through, 199 soothing rhythm breathing, 30, 57–­59; instructions for practicing, 58; mindful breathing vs., 57–­58; safe place imagery and, 146 stimulus functions, 84 substance abuse, 176, 177 suffering, CFT orientation to, 25–­26 supplementary materials, 36–­37 sympathy, 27–­28, 139 T teacher role in CFT, 34–­37; client’s lived experience and, 35–­36; supplementary materials related to, 36–­37 temperaments, 75 therapeutic relationship, 33–­48; guided discovery in, 37–­39; modeling the compassionate self in, 41–­44; roles of the therapist in, 33–­47, 198; secure base provided in, 40–­41; teaching the CFT model in, 34–­37; therapist self-­disclosure in, 47–­48; three-­ circles model and, 199–­200 therapists: characteristics of CFT, 195–­196; credibility of, 35; emotion shown by, 151; mindful breathing practice of, 102; roles performed by, 33–­47, 198; self-­disclosure used by, 47–­48 “third wave” therapies, 10, 91, 197 thoughts: cultivating compassionate, 29, 129–­140; mindful awareness of, 92–­93; threat-­based vs. compassionate, 134–­135; understanding vs. 230 judging, 56; working with threat-­focused, 130–­ 134. See also compassionate thinking and reasoning Threat Emotion Monitoring form, 124, 211–­212, 213 threat emotions: effects of, 20, 35; form for monitoring, 124, 211–­212, 213; softening the intensity of, 30, 58, 59 threat system: explanation of, 63; organization of the mind and, 65, 66–­68, 130; therapy experience and, 200 threat-­focused thoughts, 130–­135; compassionate thoughts vs., 134–­135; example of working with, 130–­134 three-­circles model of emotions, 62–­65; client interactions and, 199–­200; drive system in, 63–­64; mindfulness and, 199; safeness system in, 64–­65; threat system in, 62 Tirch, Dennis, 196 treatment planning, 179 triune brain, 49 True Strength program, vii Two Teachers vignette, 110–­113 two-­chair work, 159–­170; with compassionate and vulnerable selves, 159–­163; with compassionate, vulnerable, and self-­critical selves, 163–­170 U understanding. See compassionate understanding unintended consequences, 176–­177 V vulnerable self: chair work with, 159–­170; extending compassion to, 119–­123 W walking mindfully, 102 warmth, 16, 196; modeling with clients, 42; therapeutic context of, 26, 41 worksheets. See formsMOR E BOOK S from NE W HA R BI NGER PUBLICATIONS DBT MADE SIMPLE A Step-by-Step Guide to Dialectical Behavior Therapy ACT MADE SIMPLE An Easy-To-Read Primer on Acceptance & Commitment Therapy ISBN: 978-1608821648 / US $39.95 ISBN: 978-1572247055 / US $39.95 THE ACT PRACTITIONER’S GUIDE TO THE SCIENCE OF COMPASSION Tools for Fostering Psychological Flexibility ISBN: 978-1626250550 / US $49.95 THE COMPASSIONATE MIND A New Approach to Life’s Challenges ISBN: 978-1572248403 / US $24.95 MINDFUL COMPASSION How the Science of Compassion Can Help You Understand Your Emotions, Live in the Present, and Connect Deeply with Others ISBN: 978-1626250611 / US $18.95 MINDFULNESS MEDITATION IN PSYCHOTHERAPY An Integrated Model for Clinicians ISBN: 978-1626252752 / US $39.95 An Imprint of New Harbinger Publications newharbingerpublications 1-800-748-6273 / newharbinger.com (VISA, MC, AMEX / prices subject to change without notice) Follow Us Don’t miss out on new books in the subjects that interest you. 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