Compassion-focused therapy

Written by Katherine Nicholls

Katherine Nicholls

Counselling Directory Content Team

Last updated October 2017 | Next review due October 2019

Compassion-focused therapy (CFT) looks to help those who struggle with shame and self-criticism. Often these can be the driving forces behind other mental health conditions like anxiety and depression.

The approach was founded by Paul Raymond Gilbert, a clinical psychologist. It is considered an integrative therapy as it uses tools from other psychotherapies. It also uses research and tools from Buddhism, neuroscience and evolutionary therapy. Keep reading to find out more about compassion-focused therapy, what it can help with and what techniques are involved.

What is CFT?

It should first be noted that all talking therapies will involve compassion. The premise of counselling itself involves you being kinder to yourself and taking control of your mental health. What makes compassion-focused therapy different however, is that it looks at helping you consciously develop your ability to be more compassionate towards both yourself and others.

The founder of CFT, Paul Raymond Gilbert, noticed that many of his clients suffered from very high levels of self-criticism and shame. He found that just cognitive behavioural therapy (CBT) alone didn’t seem to help. While they gained a better understanding of their thinking patterns and how these affected behaviour, essentially it didn’t make them feel better.

Gilbert discovered that they needed tools to help soothe themselves too. So, he developed compassion-focused therapy - an approach to help create a positive emotional response for those who were dealing with low self-worth. The therapy can be used alone, but it can also be used alongside other therapy types, adding another layer of support.

How it works

Compassion-focused therapy looks at evolution theory and how this affects the way we think. Essentially, us humans have two parts to our brains. The primitive or ‘old’ part helps us survive. It ensures we have food, shelter, are loved and are safe. This part is also responsible for the fight, flight or freeze stress response. It tends to be here where problems like anxiety, and even sadness stem from.

The modern or ‘new’ part of the brain has come about during the evolution process. This part allows us to have a sense of self and lets us imagine and visualise. We can come up with ideas and choose how we want to live.

The thing is, the new and old parts can often conflict or get confused. The basic and instinctual drivers of the old part can take over and create protective emotions (like anxiety).

Cognitive behavioural therapy can help us understand this in greater detail and explain why we feel the way we do. It helps us learn to notice and then change the way we think. Compassion-focused therapy takes this a step further, for those who need it.

CFT helps us let go of the self-blame we can often attach to negative thoughts.

We often think having negative thoughts or feelings is bad or ‘wrong’ and that we are choosing to think like this, therefore we are a bad person, but the truth is nobody chooses to. Our brains evolved to react and sometimes they don’t react in a positive way.

The therapy also helps us generate emotions that can help change our thought patterns - like compassion. The brain is designed to create kindness and compassion as well as the more protective emotions like stress and anxiety, it’s just a case of learning how to activate this part of the brain.

The idea of generating compassion to help improve well-being actually stems from ancient Buddhism. Studies have proven its effectiveness too. Research has found that by developing our compassion we can create positive effects on our brain and our immune system.

compassion-focused therapy image

The three affect systems

One of the key theories behind compassion-focused therapy is that within our brain there are interconnecting ‘systems’ that need to be managed in order to improve mental health.

The threat system - This system is protection-focused. This means it will be on high-alert for perceived threats and will react with feelings like anger, anxiety and other protective emotions.

The drive system - This system motivates us to get resources and is excitement-focused. As well as focusing on getting basic needs met, like food and shelter, this system is also keen for us to achieve goals like passing a test or succeeding on a date. It’s related to feelings of excitement and arousal.

The contentment system - The ‘soothing’ system. This is triggered when there is no perceived threat or when nothing needs to be achieved. It makes us feel calm, peaceful and safe. This leads to us feeling content, happy and socially connected.

It’s believed that when these systems become unbalanced, it can lead to problems. The aim of compassion-focused therapy therefore is to regain the balance between the systems. The focus is typically on developing the contentment system to help regulate the other two systems.

Techniques used in CFT

There are lots of different tools and techniques used within compassion-focused therapy, some of which are drawn from other therapies. The primary technique used is called compassionate mind training, or CMT. This aims to help people experience compassion and develop non-condemning attributes.

Here are some of the techniques and exercises that may be used: 

Mindfulness - This helps you learn how to pay attention to the present moment without judgement.

Appreciation exercises - These may include making a list of things you like in life, the aim is to help you savour the moment, notice when something enjoyable happens and other positive, rewarding behaviours.

Compassion-focused imagery exercises - This may involve guided memories and fantasies to help stimulate the soothing system.

For those who struggle to experience or express compassion, questioning techniques may be used to help identify (and remedy) what could be causing this.

Who can it help?

Compassion-focused therapy is particularly helpful for those who have the following:

  • deep feelings of shame or guilt
  • a history of bullying
  • a history or physical or emotional abuse
  • an unrelenting inner critic
  • difficulties trusting
  • difficulties (or an inability) to feel kind towards themselves

It can therefore be helpful for those with the following mental health challenges:

The nature of the therapy means it can be challenging for some people. For example, if someone is afraid of compassion, doesn’t believe they are worthy of support or is struggling with intense anger or rage.

Knowing your options and talking them through with your doctor can help you figure out which treatment option will be the most helpful for you and your circumstances.

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