ACT With Compassion

“Is compassion important?” may seem like a no-brainer question, akin to “Do you like puppies?” But just how important is compassion in the medical profession?

Dr. Stephen Trzeciak, a physician in an intensive care unit and self-proclaimed ‘research nerd’ dove into the evidence base to investigate. After reading more than 1000 abstracts and 200 papers, he came to the conclusion that compassion isn’t just nice, it’s vital. It’s not just the cherry on top, it’s the whole sundae.

Without realizing it, for most of my life I followed the maxim “If it’s the hard thing, it’s the right thing.” I often pushed myself too far. Exercise would result in injury when I didn’t pay attention to my body’s needs for rest and recovery. I’d get burned out at work when I forced myself to do the hard things and ignored what I enjoyed or found meaningful. I’d lose out on fun and connection because I was so focused on working hard and getting things done.

Many people who are highly self-critical will understand this experience. It makes sense in a way. If you’re constantly being critical of yourself for not being/doing good enough in some way, it might seem like the way to appease that self-critic is to just try harder, toughen up, excel or just GET.IT. DONE! That’s the strategy I tried for too many years.

For those of us, like myself, with a history of harsh self-criticism, it may seem like the last thing in the world we need to do is cultivate self-doubt! We often feel like we’re doubting ourselves constantly, for example, when we second guess or criticize ourselves.

Paradoxically, this tendency toward self-criticism can actually result in us being closed minded with others, because it makes receiving feedback from them even more painful than it might otherwise be. In order to protect ourselves from the pain of receiving feedback, we develop ways to avoid or block it. For me personally, I have noticed several ways I avoid or block feedback. I may not ask for feedback when it might be a helpful, for example, at the end of a therapy session that I felt unsure about, or at the end of a staff meeting. Or, I may present my opinions as facts, making it hard for others to disagree. I may come across as certain and confident when feeling anything but. I may shut down or pout after receiving feedback, making it less likely the person will want to do it again. I may come across as fragile and uncertain in the face of feedback, implying that it’s too much for me. All of these behaviors serve to (usually unintentionally) block feedback from the people in my life.

A mentor of mind, Kelly Wilson, said the following years ago about himself and it’s always stuck with me.

The levels of self-deception are endless.

There are certain phrases that stick with you because they resonate deeply. I’ve had so many times in my life where I thought I knew the answer and yet my knowing had blinded me to what I needed to learn.

However, as a person who’s been highly self-critical much of my life, I have often found it difficult to reflect on myself. Reflecting on myself brings evaluation and judgment.

Like many people, public speaking has been a struggle for me. When I first started out, I wasn’t simply anxious about public speaking, I was really bad at it. And I have the evidence to prove it. After the first psychology course I ever taught in graduate school, I was told that I had the worst evaluations in the history of the program. The problems continued in my role as a psychologist when I started giving workshops. I would bore the audience, criticize people, and be confusing. It was excruciating. I knew I was bad, but I did know how to be better. I kept trying, but I felt like I was failing again and again and again. The hours, and often days, after workshops would be filled with shame and self-loathing. As I think back on that younger me who went through that, I feel sadness for how much pain he endured. That younger me didn’t know any better at the time and was only doing his best.

Many researchers in English-speaking countries describe shame as uniformly maladaptive, and guilt as uniformly adaptive. In fact, a quick Google search of the terms pops up headings such as, “Shame is Lethal,” “Why Guilt is Better than Shame,” and “Guilt Versus Shame: One is Productive, the Other isn’t…” And, in fact, research does tend to show that in independence-focused cultures such as much of the USA and Europe, shame and how people cope with shame tends to be more problematic. Yet, a more nuanced perspective of emotions emerges when we begin to consider how emotions function in context. One relevant context is culture. In particular, people from more interdependent cultural contexts, such as much of Asia, tend to see shame as more adaptive and valuable, and the research seems to support their experience. In general, shame in these cultures is not as reliably associated with problems with mental health or social functioning and appears to serve valuable functions.

Those of us who struggle with shame and self-criticism often believe that we are alone and different from others. We may also be more likely to be lonely and to have fewer close relationships, since shame and self-criticism can interfere with connection. In our groups for people who are highly self-critical, we have found that having the group extend wishes of lovingkindness to each group member using personalized lovingkindness phrases can be a powerful connecting experience and can help activate peoples’ social safety systems.

Very often the best innovations are born out of collaborations. That is the case with the exercise we want to share with you this month, which we call “Holding and Being Held.” This exercise evolved from one I used when teaching “Abnormal Psychology” to help with perspective taking. Our friend and colleague, Robyn Walser, Ph.D. took that original exercise and modified it to use in pairs in her training workshops. We loved Robyn’s modification. The version you will see here is modified even further for use first in our AWC trainings and now in our “Big Heart, Open Wide” class. We hope that some of you will also be able to add your own modifications to best suit your purposes. And we’d love to hear from you if you come up with versions that you think work well.

In addition to the sequence of lovingkindness meditations we have created for use with highly self-critical clients, we have found that it is often powerful for the phrases used in lovingkindness meditations to be customized for a particular person. The goal is to identify personalized lovingkindness phrases based on the client’s own idiosyncratic experience that are responsive to their emotional needs. The goal of this is to enhance the activation of the social safety system by making the phrase more personally relevant.

One of the core processes in Acceptance and Commitment Therapy (ACT) is “self as context” work, or, as we prefer to call it, flexible perspective taking. In our work with those struggling with chronic shame and self-criticism, this flexible perspective taking is key to helping individuals to develop a more compassionate perspective towards themselves and others. In this work, the idea is to help individuals begin to see themselves as a conscious person with whom they have a relationship, just like they have relationships with others.  Once they see themselves someone with whom they have a relationship, they are then in a position to be able to get in contact with their values for relationships and begin to apply those to themselves. The idea of having a relationship with oneself is often a novel idea for clients. The question, “What type of relationship do you want to have with yourself” often results in either confusion or else an “aha” moment for clients, which can be signs that you are entering new territory where learning can occur.