Case Conceptualization - Identifying key relationships or events that have contributed to the person’s current ability to experience warmth and compassion for themselves

Below is some guidance on case conceptualization using this month’s Tool of the Month - Exploring the Past - Warmth and Compassion.

One of the first steps in case conceptualization with shame-prone and self-critical clients is to assess their relational history with shaming/criticizing and compassionate/caring others. As mentioned in our previous blog post, understanding clients’ relational history of being treated with warmth and compassion can identify resources for self-compassion building work, and identify barriers to self-compassion and to letting warmth in from others.

In this part of the conceptualization, the therapist is probing for relationships and experiences in which the person felt a sense of love, connection, kindness, compassion, or warmth. Common relationships to probe for include:

  1. Excellent teachers or mentors who cared about the person and strove for them to do well
  2. Family members or attachment figures (parents, relatives, siblings) that were non-abusive and/or expressed warmth
  3. Friends that were warm and caring and non-competitive
  4. Periods of life where the person felt like they fit in or were valued, such as at a summer camp or on particular vacations or during particular activities
  5. Religious/spiritual experiences with a warm or loving God
  6. Pets and other animals that the person loved or felt loved by
  7. People (and animals) that they are able to feel kindness, compassion, and warmth toward, at least at times

Sometimes clients find it difficult to identify memories of warmth from others in their life. This may particularly be the case if they have experienced severe or chronic abuse or neglect by people close to the.  If they are unable to come up with any such people or experiences, here are some other avenues to explore with the client that might have elicited feelings of warmth at some point in their lives – even for a moment.

  1. Spending time in nature
  2. Imaginary friends that kept the person company growing up when it was hard to find warmth elsewhere
  3. Characters in books, movies, or on TV who demonstrated warmth for others or who elicited warmth in the person
  4. Particular stuffed animals or special toys

Other areas to explore for people with very few memories of warmth are sensory experiences of physical warmth like drinking tea or eating soup by a fire, or of being in a warm bath. Through careful exploration, most people are able to identify at least some relationships and situations in which they experienced compassion and kindness. For those who are not able to identify experiencing of compassion and kindness, they may be able to identify experiences of emotional warmth through imaginary or sensory experiences of physical warmth.

For people who are highly self-critical and shame-prone, contacting and describing moments and relationships containing warmth and love can be just as difficult and scary as reporting on experiences of being criticized, shamed, abused, or bullied. These memories and experiences are often associated with intense vulnerability. People who are self-critical and shame prone have often learned to not allow themselves to experience the openness, emotional vulnerability, and letting go of defense associated with feeling warm and loving emotions. Paradoxically, discussing experiences with compassion and kindness can elicit the threat response and the person’s characteristic ways of responding to feeling threatened. People might have been abused in the past when they let their guard down, they may have learned that compassion is something to mock or ridicule, or they may have simply lacked experiences of warmth in their life. Present day attention to compassion may evoke shame, grief and other painful emotions for these types of reasons.

The ability to identify several touch points for compassion and kindness is an important strength that not all clients will have. Sometimes, the person’s history is so deprived of love and warmth that they have never been able to develop the ability to identify, or even experience affiliation, safety, and contentment-based emotions. If, through this exploration, the client comes to an awareness that they have never experienced these sorts of emotions with another person, this can lead to a grieving process for the love that was never experienced and the relationships that were hoped for. If this kind of an experience is elicited, it is the therapist’s job to serve as a kind and compassionate observer and empathic listener so that the client can begin to develop a perspective of a loving and kind other who cares about their welfare. Sometimes, it is through the relationship with the therapist that the individual is able to really experience this type of kind and compassionate relationship for the first time in their lives.  This is not to say that the client has never had people around them who were kind and caring, but rather that the client has not been sufficiently able to see and experience the perspective of a kind and caring other in relation to themselves. This is a fairly complex cognitive task but an extremely important one. Therefore, it is imperative that the therapist is able to be warm and loving with their clients. It is also important for the therapist to be able to coach the client in explicitly taking the perspective of the therapist in order to develop this new, gentler perspective. For example, while conducting a perspective taking exercise with a particular client, I asked the client to move into my chair and observe herself from that perspective. I asked her whether she had ever known someone who was kind to her in moments like this. For a moment, the client paused, appeared sad, and said, “only you.” Based on this, the client was asked to imagine what I might be feeling and thinking about her as I observed her feeling upset and overwhelmed. It was apparent that the client had a poor understanding of my emotional experience and sense of empathy towards her. I was able to empathically share my emotions and thoughts that I had been feeling. She was then asked to imagine what it would be like to feel and think those things towards herself. Through this process, the client hopefully strengthened her ability to imagine the perspective of a more compassionate other viewing herself in difficult moments.

One possible prompt for this discussion is the Early Memories of Warmth Scale.

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