pluralistic influences in Compassion Focused Therapy

Hannah Gilbert, The Compassionate Mind Foundation

I recently visited Edinburgh’s Royal College of Psychiatry’s exhibition Moonstruck, which explores 500 years of mental health. There are so many ways in which we have tried to both make sense of psychological suffering, and provide forms of care or treatment, but not all of it has been either effective or particularly caring. Being aware of our collective past feels so important for a better understanding of our contemporary models, and how we have got to where we are now. Many of these historical practitioners, no doubt, were motivated by compassionate intentions, but simply didn’t know any better. All too often the agency and narrative of the individual ‘sufferer’ was drowned out by professional opinion, and our understanding of what caused mental suffering was dogmatised by a rigid medical model that was simply too narrow. But we all suffer, in some way or another, and science is increasingly recognising that there are a wide range of bio-psycho-social factors involved.

Psychotherapy has had a less violent heritage (when compared to some of the Victorian interventions, for example), and due to its focus on dialogue as the vehicle for healing, it has always been better suited to valuing the experience and life scripts of clients. As is so brilliantly discussed on this pluralistic practice blog, how we see and treat our clients is so important for the effectiveness of our therapy, its ethics, and its meaning for those who let us into their painful, private worlds. In recent years traditional psychotherapies have been challenged by feminist and multicultural perspectives, and we’re all the richer for it – again, these perspectives work to highlight the vast differences between clients, make us question assumptions we were perhaps unconscious of, and ultimately heighten awareness and appreciation of the complex tapestry of what it is to be human. Because it is complex, and no two people are exactly the same, we need to appreciate that one size can never fit all, so the more space we give to pluralistic discussion and investigation, the more we can expand our resources. As we recognise that the human mind is multi-factorial, so too must be our psychotherapies.

Compassion Focused Therapy (CFT), which emerged in the first part of the 21^st century, recognises the power of dialogue. Utilising an approach rather similar to pluralism, it has sought evidence and influence from a variety of difference sources – as well as client experience – to bolster talking therapy with a range of experiential and body-based practises, designed to stimulate specific physiological changes. CFT recognises that we are all biological beings who are socially embedded, and so sees psychotherapy as, not just about changing our relationship with our brain, but changing the relationships between brains, and giving attention to the ways in which we influence each other’s biologies. In practise, this kind of terminology does not mean we don’t respect, respond to, and treat our clients as vibrant individuals – this ethic, which is at the heart of pluralistic approaches, is so hugely important. We use what we have learnt to be helpful and, where possible, to illuminate to our clients that so many of the things that they feel are due to their own personal ‘faults’ or ‘weaknesses’ are really the consequences of having ‘tricky’ brains that can make living difficult. Therapists struggle with these things too, and I think it’s important to meet our clients here, at this crossing point of experience, both so that we can better relate, but also to challenge problematic power dynamics.

Psychotherapies have so much to learn from scientific areas like neuroscience, and becoming educated in these means that you can have a far more robust understanding of why we do what we do with clients, why certain things are really hard, and why certain things might be helpful. One of the primary catalysts for the development of CFT came from a clinical recognition of barriers to change: ‘I know these thoughts are bad for me, but this is how I feel. ’ What clinicians were finding was that clients understood what the techniques were designed to do, understood that their thoughts were contributing to their distress, but couldn’t shift the fact that these very things felt authentic. CBT has addressed this – the ‘head heart lag’ – but it has not generally encouraged its practitioners to really explore the textures of how this works. CFT developed because clinicians became acutely aware that there was something very significant here about felt, sensuous experience that hadn’t been fully explored in other psychotherapeutic approaches. What they found was that, when employing some of the traditional methods of challenging these ‘maladaptive thoughts’, clients were talking to themselves in harsh, critical voices which stimulated their minds and bodies in the same way as if someone external was literally criticising them. This changed when that very voice was encouraged to become more compassionate: changing our voice tones in this way can, and does, stimulate more positive and supportive emotional textures.

Pluralistic counselling and psychotherapy seem well placed for a more holistic understanding (and therefore care of) clients, and there are so many overlaps between this perspective and CFT. These have not been fully explored and articulated – yet! While CFT is sometimes described as a ‘third wave CBT’ approach, CFT has never identified itself as such, and in fact has actually always presented itself as an integrative, pluralistic model. I’ve always felt that we need to really value and build on the fact that, even from its inception, CFT was informed by areas such as neuroscience, attachment theory, Buddhist mindfulness traditions, Jungian psychology, and person centred therapy. It does have roots in CBT, and you can certainly see that influence in certain areas. But it is called compassion focused therapy, because we know that different therapeutic schools have generated many things that can be helpful. CFT’s overarching position here suggests that whether you use micro skills, cognitive reappraisal, behavioural exposures, etc., if it’s not contextualised within a compassion experience, both in how therapy is ‘done’ as an evidence based practise but also as something infused with person centred values and a deep compassion for our clients, it may be limited.

One of the core parts of CFT is Compassionate Mind Training (CMT), which involves training the mind to be orientated toward being helpful not harmful. CMT has now developed beyond the therapy room – research is currently underway to explore its effectiveness in schools and businesses, and it’s now available as an eight week course for the general public. Many CFT and CMT practitioners, like members of the pluralistic practice community, are actively involved in areas of social justice and politics, and increasingly discussing the ways in which we can implement an authentic compassion-focused philosophy and motivation within our daily lives and actions. We are questioning mental health more generally and widely, taking seriously how our social world may be impacting upon this.

Like the pluralistic community, we recognise that there is so much richness and knowledge in different approaches; and so many more questions to ask, research to undertake, and techniques to develop. All of this can be developed whilst retaining a curious eye and ear in the therapy room – not to get in the way of being truly there for our clients, but to learn from – and maintain their authority – as our valued and valuable co-participants. When we set the intention of providing the best possible therapy for our clients, putting them at the centre, rather than our tribal loyalty to specific schools, we will all benefit – and truly, it makes the most entertaining and enriching conversations about what it means to be a human being.