Compassion-Focussed Therapy (CFT) is a model of therapy pioneered by Professor Paul Gilbert OBE. It is often referred to as part of the third wave of cognitive-behavioural therapy (CBT). The first wave focused on behavioural therapy, the second wave integrated cognitive therapy, and the third wave incorporated mindfulness, acceptance, and contextual approaches to enhance traditional CBT.
Although CBT has a significant amount of research behind it evidencing its effectiveness, it does not work for everyone. A group that research and clinical experience suggests don’t respond well to CBT include people who are self-critical, have perfectionist traits, and/or experience high shame or low self-esteem. These individuals typically report they can change their thoughts and behaviours after a course of CBT, but they just don’t feel any differently. CFT is an approach which can be particularly helpful for these individuals.
It’s vital that when a certain type of therapy doesn’t work, people are offered an alternative that fits with a collaborative understanding of what’s keeping them stuck. Unfortunately, I’ve met a lot of clients who feel hopeless, “too complex” or “untreatable” because their experience of services has been that they have repeatedly been offered the same approach with the service hoping for a different outcome (which ironically is Einstein’s definition of insanity!). People who are self-critical typically blame themselves for everything, and poor treatment response is no exception. Sadly, some clinicians and services don’t discourage these people from thinking this way (as it’s easier for them to locate the problem in the client rather than taking responsibility themselves or thinking more systemically about the issues).
I often find that an early therapeutic aim when working with these individuals is typically to try and undo some of the unhelpful messages they’ve absorbed from unsuccessful experiences of services. I try to help people learn that the evidence they are using to justify their beliefs about themselves (and the hopelessness they feel) is only evidence that the right model of therapy for them hasn’t been found yet. It’s a huge privilege to watch these people thrive when they engage in a formulation-driven therapy as opposed to a diagnostically-driven one.
Formulation-Driven Approach to Therapy
A formulation-driven approach to therapy involves a collaborative process between the therapist and client to create a shared understanding of the client’s issues, which then guides a personalised treatment plan tailored to the individual’s unique experiences and needs.
Diagnostically-Driven Approach to Therapy
A diagnostically-driven approach to therapy applies the medical model to psychological issues, using diagnostic labels to categorise clusters of symptoms and prescribe corresponding treatments, often involving medication, with limited consideration for individual differences and personal circumstances.
So what does CFT involve?
CFT draws heavily on evolution-theory, neuroscience and scientific research. The first treatment session is usually fairly information-heavy as it can be helpful to have a theoretical framework and compassionate language to guide discussions. Rather than feeling like lecture, a good therapist will explain concepts using a process of Guided Discovery to help an individual recognise the truth in the theories, find out which aspects resonate well with them personally, and help the person draw upon their own experiences to explore the model.
The psycho-education involved in an early CFT session may typically include an understanding the three types of emotion-regulation system we have:
The Threat System:
The threat system is an ancient part of our brain designed to help us survive by detecting and responding to dangers and threats. This system triggers feelings of fear, anxiety, anger, and disgust, which prepare us for fight, flight, freeze or flop responses. While essential for survival, an overactive threat system can lead to chronic stress and anxiety, causing significant distress and impacting our mental health.
The Drive System:
The drive system motivates us to seek out resources, achieve goals, and strive for success. It generates feelings of excitement, enthusiasm, motivation and aliveness when we pursue and attain rewards. This system fuels our ambitions and propels us forward. However, if the drive system becomes overactive, it can lead to burnout and exhaustion, as we constantly chase after more achievements without adequate rest and recovery.
The Soothing System:
The soothing (affiliative) system helps us feel safe, calm, peaceful & content. It is activated through experiences of kindness, warmth, and connection with others. This system is essential for regulating our emotions and restoring balance, counteracting the high arousal states produced by the threat and drive systems. Cultivating the soothing system fosters a sense of well-being, reduces stress, and promotes healing and recovery.
By understanding and balancing these three systems, we can develop a compassionate mind that allows us to navigate life’s challenges with resilience and well-being. However, it is a lot harder to work with three circles than we might expect based on the mismatch between how we’ve evolved and the modern world. For example, the threat system has evolved to operate on a ‘better safe than sorry’ principle because when random genetic mutation meant certain ancestors of ours reacted every time to a noise in the bushes, they survived longer than those who didn’t (even if 9 times out of 10 it was a false alarm). Therefore, these genes were more likely to be passed down through procreation, eventually to us. Whilst this is helpful in the wild, it’s not so helpful at the weekend when we’re trying to activate our soothing system but our mind is overcome by threat-based thoughts (such as work next week). Chronic threat system activation is therefore very common in today’s world.
The 3 circle theory applies in the therapy room as much as it does in the outside world. Therefore, the therapeutic relationship is absolutely paramount as if a client cannot feel safe, they will not be able to think flexibly or learn new skills in therapy – they will typically be in the threat system and find themselves using a threat-based way of responding to their therapist (fight e.g. hostility; flight e.g. avoidance of sessions; freeze e.g. no discussion). They might also use a drive-based way of approaching therapy (and want to please the therapist or try too hard to get better, ultimately leading to disappointment in the long-term). What we want is to help clients activate their soothing system in the therapy room and so the priority has to be on helping them feel safe.
Once clients learn about the different concepts and theories from CFT and feel safe with their therapist, they can then begin to work with things like attention, self-critical thoughts, self-compassion and emotion-regulation. There are a large range of approaches and techniques associated with this work (way outside the scope of this article to discuss) and the pacing is vital. I heard someone once liken developing self-compassion to thawing frozen prawns: if you try to rush it (e.g. by running them under a tap), their consistency when cooked won’t be ideal. It’s much better to allow them the time they need to thaw gently and this will be a great investment in terms of the outcome!
Verdure Psychology offers Compassion Focussed Therapy to clients in York experiencing shame, self-criticism, low mood, anxiety or perfectionism. Contact us today to find out more.