ACT With Compassion

We are grateful and humbled that last month we reached 1,000 likes on Facebook!  As we celebrate this milestone, we wanted to take a moment to thank all our supporters over these last few years who have helped to spread the word about ACT With Compassion. We are also incredibly grateful to those of you who have given us feedback and input which has helped to improve our work. Thank you all!

Several of the folks following us at ACT with Compassion have expressed an interest in learning about how ACT with Compassion can help clients who are dealing with the effects of interpersonal trauma. Some of you have noticed that survivors tend to experience high levels of shame. Others of you have shared that compassion-focused work seems to resonate with this population. Indeed, having a history of interpersonal trauma is linked to higher levels of shame, and shame is thought to play an important role in post-traumatic stress disorder (PTSD).  Therefore, it may be beneficial to consider compassion-focused approaches with this population to address the shame-proneness and/or self-criticism that may be maintaining PTSD or other presenting problems.

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.

It’s our anniversary!!! It was two years ago this month that “Team Compassion” started the ACTwithCompassion website. Over the course of those two years the number of people following our work has grown tremendously and we feel very honored and humbled that so many of you seem to have found what we are doing here helpful in some way. Thank you!

For the last years, Team Compassion founding member Dr. Melissa Platt has been scouring journals and the empirical literature to bring you monthly research updates. In this post, we have pulled together the 20 research findings we feel are most directly applicable to working with highly self-critical and shame prone (HSC/SP) clients. And so on our anniversary, we present to you, our top 20 science-based recommendations for working with highly self-critical and shame-prone clients!!!

We at ACT with Compassion have been working out how to understand and describe the ways we could use personal perspective taking frames (from relational frame theory) in our work with shame and self-compassion. A few months ago, we wrote a post that described some examples, especially focusing on perspective taking between client and therapist. In that post we noted that during moments of high self-criticism, people tend to get fused with a conceptualized self (e.g., “I am broken”), and this narrow perspective tends to interfere with learning and connection. High self-critics (HSCs) tend to fused with a flawed conceptualized self much of the time. Thus, it is important to work with the client on multiple occasions, and sometimes in creative ways, to help them move toward a more flexible, self-as-context perspective and loosen the grip of the old shame story.

Last month we wrote about the importance of helping clients identify trustworthy others. How others respond to an individual’s disclosure of feeling shame or self-criticism can have a profound impact on the likelihood that that individual will continue to disclose content they often keep hidden. In that post we mentioned Brene Brown’s BRAVING framework as one way to help clients determine who to trust when disclosing their vulnerabilities.

My experience is that my most complex, chronic and stuck clients are often laboring under a great weight of shame. I’ve seen how shame leads them to withhold clinically useful information, how it leads to defensive and blaming behavior, and how it gets in the way of intimacy. I’ve seen how shame about their emotions, their bodies, and their thoughts impedes their self-awareness and makes it hard to be responsive to their own needs. Research also shows these observations to be true.

Have you ever felt unsure about how to help a client? Have you felt powerless to change a difficult situation in a client’s life? Have you ever worried that you were doing a client more harm than good? While those may be painful thoughts to have for you as the therapist, they may actually be good news for your clients.

Acceptance and Commitment Therapy and its related theory of language and cognition, Relational Frame Theory (RFT), outline three ways of thinking about the self.  Self as process refers to the ongoing awareness of one’s experience and the description of thinking, behaving, feeling, and sensing. Self as content (i.e., the conceptualized self) involves describing and evaluating yourself, in the same way one might describe and evaluate an object--as something that has qualities. Self as context refers to the coming together of a set of the perspective taking (i.e., deictic) frames that relate to the ability to observe and describe from a perspective or point of view. Self as context refers to the ability to flexibly shift perspective as needed by the situation. It enables or facilitates many different experiences including empathy, compassion, and self-compassion. In a more traditional ACT viewpoint, this process was often referred to as the “observing self” and can involve contact with a stable, ongoing sense of self that transcends the content of one’s experience.

A number of standardized assessments exist that may be useful in working with highly self-critical and shame prone clients. These measures can be used for obtaining initial normative assessments as well as tracking change in therapy over time. Some of these measures may even have predictive utility. For example, the hated-self subscale from the Forms of Self-Criticism and Reassuring Scale seems to respond more slowly to interventions aimed at reducing self-criticism, suggesting that highly self-loathing and self-hating clients may need more time in therapy to develop self-compassion. In our practice, we often give three measures to clients at intake and periodically throughout therapy. We typically discuss the results in some detail as part of their ongoing conceptualization. These are the three we give to clients: