ACT With Compassion

As mentioned in our previous post about guided meditations for highly shame-prone and self-critical clients, high self-critics tend to have under activated social safety systems. Under activated social safety systems are associated with loneliness, chronic alternation between striving toward achievement and fearing failure (e.g., perfectionism), depression, pervasive anxiety, and other issues that tend to bring people into therapy. Lovingkindness meditation (LKM) can basically be thought of as a workout for the social safety system.

Lovingkindness Meditation has all sorts of benefits

Lovingkindness meditation is just one of many kinds of meditation, but it’s one that has quite a bit of research data to back up its helpfulness. Lovingkindness has been shown to increase positive emotions and to help people feel more connected to others.  It’s been shown to help with migraines, chronic pain, trauma, and even schizophrenia. Because the social safety system is related to things like empathy and the ability to pick up on the social signals of other people, LKM also has been shown to help people to be more helpful to others, more compassionate, and more empathic. One randomized child showed that LKM is specifically helpful with high self-critics and helping them to be less self-critical. Research also shows that it helps in small doses. Practicing for just a few minutes has been shown to activate the social safety system for anywhere from 20 minutes to four hours afterwards.

Lovingkindness Meditation can be threatening for high self-critics

Although the evidence supporting LKM is compelling, it is important to acknowledge with your highly self-critical clients, that responses to LKM are not always going to be warm and fuzzy. Especially in the beginning of the practice when LKM is new and unfamiliar, high self-critics may actually feel threatened rather than have a sense of safety and belonging in response to the practice. There are several reasons why this might be the case. First, high self-critics may have been raised in an environment where early caregiving relationships were not adequately warm, responsive, or supportive and where cues related to social safety may have become conditioned to elicit threat. Second, many high self-critics have a history of trauma or abuse perpetrated by someone who was expected to protect or care for them and for these folks, the social safety system and the systems responsible for fight/flight and/or freeze may be activated in response to social safety cues. Third, LKM may trigger self-criticism due to the relational frames of coherence and opposition (from relational frame theory). For example, focus on the self may bring up habitual thoughts like, “I am bad,” or “I don’t deserve love.”

A Lovingkindness Sequence you may want to use

For the reasons listed above, it is important to begin LKM practice with some assessment of your highly self-critical clients. Do some exploration with them to discover what types of LKM targets most easily activate their social safety system without too much complication or interference from fight/flight or freeze. Each client is different, but we have created a sequence of LKMs that is a good starting place for highly self-critical and shame-prone clients. This practice begins with LKM for a friend or animal, then a stranger, and doesn’t bring in the self until a bit later on. Below are the recording and scripts you may wish to use with your clients.

Preparing for the first time you do the exercise

The first time you introduce LKM, it’s typically helpful to do the exercise together in the session. It may be also helpful to audio record the meditation, so that the client can listen to the therapist’s voice rather than the generic audio files below. This will depend upon the client.

In addition, it can be helpful to spend some time helping clients to identify targets for use in the exercise.  The initial LKM exercise has clients focus on a situation wherein they felt “a sense of kindness, warmth, or connection.” Since high-self critics may have a hard time recalling experiences of warmth or connection, it can be helpful to do some work to identify these before introducing lovingkindness for the first time.  Otherwise, it’s not uncommon that the clients will spend part of the meditation trying to search their memory for a relevant experience.  Our case conceptualization process can provide a structure for the therapist to help identify these moments that can be used as resources. In particular, we have written about identifying experiences of warmth and compassion and created a handout for facilitating this process.

The exercise also asks the person to “bring to mind the image of someone you care about, have warm feelings toward, or feel a sense of positive connection to. Ideally, you will pick someone where the relationship feels relatively simple and uncomplicated and where warm feelings come easily, even if they are not strong at the moment.” It’s common that clients may also have a hard time identifying relationships the feel relatively simple and uncomplicated. They may have intense relationships with others, but find these relationships conflicted or filled with self-criticism or shame for perceived failures or inadequacies. Or they may think about past relationships that were positive that they have lost, which may elicit sadness or guilt, rather than emotions associated with the social safety system. Ideally, the therapist will help the client to identify a relationship that they can use as the target of the meditation. Sometimes this relationship may even be the one with the therapist.

About the sequence we teach

This LKM sequence below was created with high self-critics in mind. The sequence begins with a person or being for whom it is relatively easy to feel warmth or a sense of positive connection (i.e., a friend). Again, the idea is to practice activating the social safety system, and we want to start by doing this in a manner that is as direct and uncomplicated as possible. Next, we move to a stranger or neutral person. The idea is to extend the practice so that the client is able to broaden their repertoire to activate the social safety system outside of the easiest contexts. A neutral person or stranger is a good next step because although they are unlikely to automatically trigger feelings of safety and connection, they are also not as likely to trigger the threat or overwhelm systems. Next, we move to the self. In traditional LKM sequences, the self is the starting point for the practice, but with high self-critics, the self is complicated, and more likely to activate the threat and overwhelm systems. We only move to the self once the client has some practice activating the social safety system in easier and more neutral contexts. Finally, in order to further broaden the repertoire, we move to practicing with a difficult person. With high self-critics, we understand that the self may still be the most difficult person at this point, and if that is the case, the client can continue to use the self as the target of practice. In each of the meditations, we start with a friend in order to prime the social safety system before proceeding to the other targets of the meditation.

Here are the recordings and scripts:

• Lovingkindness for a friend (introductory version script in Word format)
• Lovingkindness for a friend (open-ended, higher fidelity version)
• Lovingkindness for a friend and stranger (script in Word format)
• Lovingkindness for a friend and for yourself (script in Word format)
• Lovingkindness for a friend and a difficult person (who may also be yourself!) (script in Word format)

Meet your client where they are at

We recommend these meditations as a starting place with highly self-critical and shame-prone clients. However, if these practices don’t seem to be activating your client’s social safety system much at all, you can use the history of warmth assessment from the case conceptualization to determine whether it might be more effective to use other areas of focus, such as time in nature, or spiritual experiences, when you begin the practice with your client. In that case, you may want to modify our scripts and record a personalized meditation for your client based on their specific needs for activating the social safety system.

Related resources

Here's a worksheet you can use to help client's track their practice and note reactions they have for discussion in session: Lovingkindness tracking worksheet.

Working with Clients to Identify Personalized Lovingkindness Phrases -- We've created a script for a meditation exercise that you can use to guide your clients to identify their own personalized lovingkindness phrases. Developing customized phrases for lovingkindness meditations can be powerful for clients, especially if they are highly critical of themselves.