Annette Boden MSc

Compassion focused therapy and approaches

I have had the privilege to attend workshops training under Dr Mary Welford and Professor Paul Gilbert through the ‘Compassionate mind foundation’.

I have long believed that a compassionate approach to our well-being is vital for our emotional stability and I have incorporated a compassionate approach in my work and life for many years.

I believe that Compassion focused therapy is a vital piece of any therapeutic intervention utilising an integral approach and I use some of the techniques within my own therapy practice.

I felt that it would be a good idea to give some further information on this approach. I came across an excellent article by Julia Bueno on the internet which I believe gives a clear and full explanation.

 

I recently completed a three year MSc in Consciousness and Transpersonal Psychology. As part of this I completed a thesis on the subject of compassion and self-compassion entitled:

“A phenomenological study of experience of participation in an eight-week compassion focused, therapeutic well-being programme”.

(Below is a precis of my study. There is a published article in the North East branch of the BPS Spring 2013 newsletter. You may obtain a downloadable copy from the BPS (The BritishPsychological society).

BPS main address St Andrews House, 48 Princess Road East, leicester, LE1 7DR. TEL. 0116 254 9568).

“Compassion -Wishing that oneself or others be free from suffering. Empathy in the face of suffering, and the wish to alleviate it. From the Latin, com(with) and pati (suffer).
Self-compassion includes: 1. Self-kindness Vs Self-criticism; 2. Common humanity Vs Self-isolation
3. Mindfulness Vs emotional entanglement.”
Kristin Neff

Abstract

This study explored the experience of cancer patients undergoing a well-being programme which focuses on compassion for self and others.

The focus of the study concerned the ‘lived experience’ of applying compassion and self-compassion whilst learning a number of coping strategies and techniques, such as mindfulness and meditation and other compassion focused activities. The programme was developed to help people cope better in their everyday lives in relation to their ongoing journey through cancer and recovery.

Five female participants who had undertaken an eight-week programme at a day hospice were interviewed. An interpretative phenomenological analysis was completed to draw out the emergent themes occurring within the dialogue.

Emergent themes indicated that there was a reduction in anxiety levels and an increased sense of well-being; self-compassion was learnt from compassion; self-compassion was more difficult to apply than compassion. This difficulty was considered to be cultural and learnt. Self-compassion can be learned and supported by the practices of mindfulness and meditation. There are positive benefits to being in a group and sharing the experience.

It is hoped these results will provide useful information to the medical and psychological professions, and help us to understand how we may develop greater resilience to life’s challenges and improve the quality of the lived experience of being human, social, interconnected beings.

Introduction

Compassion focused therapy is a new and emerging field as a therapeutic intervention. This relatively new therapy may benefit people with a range of physical and emotional difficulties, beyond those already explored in previous research. The current study aimed to explore the ‘lived experience’ of Compassion focused therapeutic techniques being employed in a group based well-being programme where participants suffered from a range of psychological issues.

The wealth of empirical research already undertaken over the last ten years suggests and supports the view that applying compassion and self-compassion is associated with an increase in mental well-being and reduces the effects of anxiety and depression. Key components supporting self-compassion are mindfulness and meditation. Neff suggested that “self-compassion is an important human strength as it evokes qualities of kindness, equanimity, and feelings of inter-connectedness, helping individuals to find hope and meaning when faced with the difficulties of life” (Neff et al. 2007). All of these aspects of self-compassion unfold within the compassion focused therapeutic approach to therapy that was borne out of research carried out by Paul Gilbert (2010).

 

The hospice course

The hospice course is an eight-week compassion focused well-being programme. It consists of eight two-hour weekly group sessions incorporating “the idea of a ‘support group’ so that those attending the sessions have an ongoing opportunity to share experiences and feel the support of the group” (Exert taken from the course manual). The core structure of the course includes the development of compassion for self and others. The sessions include exercises such as mindfulness, meditation, compassionate letter writing (Kristin Neff) and the use of compassionate imagery (Gilbert 2010). Mindfulness was one aspect of the course that was introduced to the participants, as mindfulness and compassion and self-compassion, according to the eastern philosophy that the compassion focused philosophy of the course was based upon, goes hand in hand with compassion and is an essential element (Neff 2003a).
The study

There is already a wealth of quantitative research being undertaken, providing encouragingly consistent results regarding compassion and self-compassion. This study aimed to look in depth at the ‘how’ and the ‘why’ to enrich and add to the research already available.

Interpretative Phenomenological Analysis (IPA) was employed as this qualitative methodology and epistemology benefit a deeper understanding of the ‘lived experience’.  It is the ‘how’ and the ‘why’ self-compassion impacts positively on psychological functioning and well-being that was considered in this study.

Results

By drawing together composite superordinate and subordinate themes from the five participants that were interviewed, a number of significant and complementary themes emerged. All of the participants were at a stage in their cancer journey where they had completed chemotherapy and/or surgery when they began the course. Some were waiting for results.However, all of the participants reflected on achieving change after attending the course, in some way that was positive.

Key findings

In summary, the key findings in the current study supported previous research.

  • The participants reported that there was a sense of being able to be completely honest and open about their lived experience both within the group and in their everyday lives during the course.
  • All of them reported positive change as a result of applying self-compassion and attending the course.
  • The study found that self-compassion was a learnt experience and learnt from compassion.
  • Some reported a reduction in anxiety and an increased sense of well-being, and compassion coming easier than self-compassion, supporting the findings of Pauley and McPherson (2010).
  • Self-compassion was hard to apply whilst struggling with difficult emotions and lack of self-acceptance. This supported Pauley and McPherson’s (2010) findings that applying self-compassion was difficult to apply when depressed as this affected ability to apply self-compassion.
  • Positive Change occurred – temporal, embodied, and intersubjective and self-compassion as relational supported previous findings that applying self-compassion “predicts positive psychological strengths…and appears to facilitate the ability to grow, explore, and wisely understand oneself and others” (Neff 2007).

 

  • Even after completing the course an interesting theme and use of language repeatedly came up. In all but one of the interviews self-compassion was described in terms of being ‘selfish’ whether in a positive or negative way this was a chosen word, which is suggestive of a shared cultural discourse.
  • The participants spoke about compassion being learnt and cultural learning of putting others before their own self- concern. This supported previous research that suggested self-compassion levels differ in different cultures (Neff 2008)
  • The participants reported an increased sense of well-being and had found the practice of mindfulness helpful. This enabled the participants to manage their day to day experiences less anxiously.

The researcher’s experience

As a co-participant on the course, my own personal experience was one of transformation. I felt a deep sense of connection with the participants through the privilege of being accepted into the group and being able to share their lived experience. I experienced and witnessed interconnectedness and deep empathy and compassion and this was borne out in the interviews. The interviews were candid and honest. I was moved deeply and profoundly by the recounting of the participants’ cancer journey, and the sharing of their deeply personal experiences, and the courage and compassion they showed towards me in agreeing to be interviewed and completing the interviews.

 

Implications of the study for clinical pathways.

 

It will be interesting to consider the implications of the  findings for healthcare in general and how a compassion focused therapy programme can be incorporated into therapeutic models in primary care settings, hospices, etc, and particularly when funding for such programmes is being considered. Time taken to process the course contents was different for each participant, depending on what was happening for people, physically and emotionally.

Also, this study hopes to show evidence of the beneficial aspects of compassion and self-compassion on psychological well-being in times of stress and major life events such as serious and life threatening illness, and the associated psychological distress, and management of this.

 

Future research

It may be useful to consider a longitudinal study to establish whether or not the benefits of applying the techniques remained with participants and for how long, to perhaps establish outcome measures for maintaining positive changes made. Combined with a full compassion focused programme it would be useful to see long-term changes.

With ‘happiness’ being high on the British Government agenda, and in light of Alistair Campbell’s recent e-publication ‘The Happy Depressive’ (Campbell, 2012) : Further qualitative research may be useful for exploring further the effects of compassion and self-compassion on happiness.

Key References

Campbell, A. (2012) The Happy Depressive. Kindle e-book. Brain shot series. Random House.

Gilbert, P. (2010) The Compassionate Mind. Constable and Robinson Ltd. London.

Neff, K. d. (2003a) Development and validation of a scale to measure self-compassion. Self and Identity, 2, 223-250.

Neff, K.D., Rude, S.S., Kirkpatrick, K. L. (2007) An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of research in personality 41, 908-916.

Neff, K.D., Pisitsungkagarn, K., and Hseih, Y. (2008) Self-compassion and self-construal in the United States, Thailand, and Taiwan. Journal of Cross-Cultural Psychology, 39, 267-285.

Pauley, G. & McPherson, S. (2010) The experience and meaning of compassion and self-compassion for individuals with depression or anxiety. Psychology and Psychotherapy: Theory, Research and Practice, 83(2), 129-143.

I would also recommend that you take a look at the website of the compassionate mind foundation

www.compassionatemind.co.uk for more information.

Professor Paul Gilbert has also written an excellent book “The compassionate mind” which I recommend to all my clients.

I also highly recommend the work of Professor Kristin Neff and her book “Self compassion”.

Kristin Neff http://www.self-compassion.org/ and her colleague Christopher Germerwww.mindfulselfcompassion.org will be running workshops in the UK in 2013 following on from their hugely successful and well received intensive training programme in Mindful self-compassion this summer.

Below is the link for an  article about Compassion focused therapy by Julia Bueno taken from ‘Therapy today. For the original article you can go to

http://www.therapytoday.net/article/show/2515/

 

Recommended reading

There are a number of books relating to this field which I highly recommend:

Kristin Neff “Self-Compassion”

Christopher Germer “The mindful path to self compassion”

Professor Paul Gilbert OBE “The Compassionate Mind”, “Overcoming Depression”

Ken Goss ” The Compassionate Mind approach to overeating”

Mary Welford “Building your self-confidence using Compassion focused therapy”

Deborah Lee with Sophie James “Recovering from Trauma using Compassion Focused Therapy”

Dennis Tirch “The Compassionate Mind approach to Overcoming anxiety”

 

 

Here is a video with Professor paul Gilbert, Kristin Neff, and Christopher Germer filmed earlier this year