We are not born with an inner critical voice, but many of us develop potent inner critics through internalising and responding to our early lived experiences. Research indicates that in the treatment of eating disorders, higher levels of self-criticism and lower levels of self-compassion are related to a higher severity of symptoms and poorer outcomes for treatment. Individuals with eating disorders are also more likely to have higher levels of shame and higher levels of fear of compassion. Although this research is focused on eating disorders, it is also applicable to other mental health conditions, if not all.
What is Compassion Focused Therapy?
Compassion Focused Therapy (CFT), developed by Dr Paul Gilbert, is focused on helping clients develop a compassionate mindset to help address self-criticism and shame. CFT is used to treat multiple clinical disorders and continues to show promising results. Applying the treatment can however raise certain challenges in the context of fears, blocks and resistance to compassion itself, as well as changing or losing our inner critic.
There are certain key emotional needs a child requires from their environment and caregivers in order to thrive. The less consistently a child has these emotional needs met, the more likely they will struggle with a potent inner critic, fear of compassion from others and compassion to self. Therapists have been challenged to deal with these obstacles, and in this blog post we will explore these in a little more detail.
Facing Fears
Fear often stands as a big roadblock on the way to building compassionate capacities and managing shame and self-criticism. Working with this is central to CFT. Therapist’s work with clients often focuses on exploring the origins of these fears and its current presentations, whether it be:-
Each of these fears has an important function for the client, which is explored and then considered in therapy. Treatment then involves supporting the client to develop compassionate capacities to understand how they want to be in the future with each of these fears; before moving towards their value-based direction. In the context of an inner critic, CFT helps build capacity to work with our critic. This enables us to then retain aspects which we consider beneficial, such as accountability, while modifying or replacing aspects which are dis-empowering, induce shame or may hold us back.
Dealing with Blocks.
It can be both the content, as well as how our critical voices talk to us, that play a significant role in how we feel, our urges and behaviours. Therapeutic interventions can therefore involve helping clients tackle negative self-talk, obsessionality, intrusive thoughts or images, deep-rooted beliefs, and thoughts that further negatively impact progress (for example believing they deserve to be ashamed and be forever punished by their critic).
Similar approaches to managing fears are likely to be employed to be able to consider the blocks from a wise, courageous, and compassionate perspective, before deciding what they may want for themselves going forward. Practical tools may also be employed to help understand how the brain works, to develop improved capacities to notice our thought patterns and emotional states and urges. Therapists can help break down these mental roadblocks, and help replace self-attack, shame and dis-empowerment with increased compassionate capacity to confront new situations with our most capable versions of ourselves.
Pushing Back on Resistance.
Some people are not sure that compassion is beneficial for them or want to modify or work with their inner critics. Some may say this is not matching their personality or approach to life. Therapists tend to validate this perspective, but also explore the aspects of compassion the client feels may be beneficial for them. Treatment is then adapted to better suit the client’s needs and values. Sadly, those that would benefit most from a compassionate approach are likely to have the most resistance, because having their emotional needs met is likely to be unfamiliar or linked to abuse. By slowly introducing aspects of the treatment which the client feels may be beneficial, it can give the client space and time to relate to compassionate concepts.
What other skills are learnt during Compassion Focused Therapy?
Compassion Focused Therapy is not only focused on conversation; it is about practical tools that can be implemented in everyday life. Therapists use exercises involving imagery-based techniques, role play, psychoeducation, and attention training practices to manage symptoms and obstacles presented by the clients, to help implement a more compassionate approach. They may share real stories and practical examples, showing how these tools can work in the real-world settings. For example, the use of imagery to manage internal conflicts and self-attack from the critic in our heads, as well as imagery to manage external conflict from our past, present or even future feared situation.
Our experience using Compassion Focused Therapy.
“The vast majority of the clients we see at The Body Image Treatment Clinic, struggle with shame and a potent inner critic on some level. We are fully aware that if left untreated then any gains or sense of confidence from therapy will be fickle and short lived. For this reason, our treatments of choice involve combining evidence-based approaches which bring about early change in symptoms, dovetailed with building compassion-based capacities to manage shame and self-criticism. In essence, retro-fitting those key emotional components all children, as well as adults, need so they can thrive. Many clients initially fear that losing their critic will somehow make them weaker or less accountable but once they find out what the term compassion really means in practice, they soon realise the opposite of this to be true.”
- Thomas Midgley CBT & Compassion Focused Psychotherapist, Highly Specialised Eating Disorders Dietitian & Founding Director at The Body Image Treatment Clinic, Harley St, London.
In Summary.
A Compassion Focused Therapy approach focuses on cultivating the capacity to treat ourselves in line with our values and in doing so, moderate any shaming, disempowering, critical parts, to enable us to bring the best version of ourselves to future challenging situations.
References: · Self-compassion, body image, and disordered eating: A review of the literature - ScienceDirect · https://onlinelibrary.wiley.com/doi/full/10.1002/capr.12530 · https://www.sciencedirect.com/science/article/abs/pii/S2352250X18301222 · https://www.taylorfrancis.com/chapters/edit/10.4324/9781003035879-7/formulation-fears-blocks-resistancespaul-gilbert-paul-gilbert-gregoris-simos · https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/introducing-compassionfocused-therapy/ECBC8B7B87E90ABB58C4530CDEE04088
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